Provider Demographics
NPI:1487629648
Name:THE WOMEN'S CLINIC, AMC
Entity Type:Organization
Organization Name:THE WOMEN'S CLINIC, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-377-8855
Mailing Address - Street 1:431 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2933
Mailing Address - Country:US
Mailing Address - Phone:318-377-8855
Mailing Address - Fax:318-377-8852
Practice Address - Street 1:431 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2933
Practice Address - Country:US
Practice Address - Phone:318-377-8855
Practice Address - Fax:318-377-8852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1457418Medicaid
LA1567094Medicaid
LA1932132Medicaid
LA1133850Medicaid
LA1187879Medicaid
LA1567094Medicaid
LA5C455Medicare PIN
LA5N933C455Medicare PIN