Provider Demographics
NPI:1609832831
Name:AFFINITY HEALTHCARE FOR WOMEN
Entity Type:Organization
Organization Name:AFFINITY HEALTHCARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-536-7400
Mailing Address - Street 1:1708 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7015
Mailing Address - Country:US
Mailing Address - Phone:870-536-7400
Mailing Address - Fax:870-536-6304
Practice Address - Street 1:1708 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7015
Practice Address - Country:US
Practice Address - Phone:870-536-7400
Practice Address - Fax:870-536-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7497207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C807Medicare PIN