Provider Demographics
NPI:1700012184
Name:CONTEMPORARY HEALTHCARE FOR WOMEN
Entity Type:Organization
Organization Name:CONTEMPORARY HEALTHCARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-754-5337
Mailing Address - Street 1:1100 E POPLAR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-4419
Mailing Address - Country:US
Mailing Address - Phone:479-754-5337
Mailing Address - Fax:479-754-5348
Practice Address - Street 1:1100 E POPLAR ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4419
Practice Address - Country:US
Practice Address - Phone:479-754-5337
Practice Address - Fax:479-754-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-30
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4826207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR771101602OtherBREAST CARE
AR178187002Medicaid
AR178187002Medicaid