Provider Demographics
NPI:1669491791
Name:WOMEN'S HEALTH CLINIC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-688-8804
Mailing Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3133
Mailing Address - Country:US
Mailing Address - Phone:318-688-8804
Mailing Address - Fax:318-688-5473
Practice Address - Street 1:2508 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3133
Practice Address - Country:US
Practice Address - Phone:318-688-8804
Practice Address - Fax:318-688-5473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494810Medicaid
LA1578991Medicaid
LA1126659Medicaid
LA5E684Medicare ID - Type UnspecifiedDR FREDERICK KINDER
LA51766Medicare ID - Type UnspecifiedDR JERRY DYESS
LA1578991Medicaid
LAB63343Medicare UPIN
LA1494810Medicaid
LA1126659Medicaid