Provider Demographics
NPI:1437583044
Name:SPELL FITCH WOMEN'S CARE, LLC
Entity Type:Organization
Organization Name:SPELL FITCH WOMEN'S CARE, LLC
Other - Org Name:ANGELA N SPELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-621-7700
Mailing Address - Street 1:614 NW ENGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3973
Mailing Address - Country:US
Mailing Address - Phone:816-621-7700
Mailing Address - Fax:816-621-7707
Practice Address - Street 1:614 NW ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3973
Practice Address - Country:US
Practice Address - Phone:816-621-7700
Practice Address - Fax:816-621-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003003400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208364703Medicaid
F69C336Medicare PIN
H81093Medicare UPIN