Provider Demographics
NPI:1700017191
Name:MEXICO WOMENS HEALTH SPECIALISTS LLC
Entity Type:Organization
Organization Name:MEXICO WOMENS HEALTH SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-581-7040
Mailing Address - Street 1:626 E SUMMIT ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3298
Mailing Address - Country:US
Mailing Address - Phone:573-581-7040
Mailing Address - Fax:573-581-3302
Practice Address - Street 1:626 E SUMMIT ST
Practice Address - Street 2:SUITE J
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3298
Practice Address - Country:US
Practice Address - Phone:573-581-7040
Practice Address - Fax:573-581-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36175207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502427404Medicaid
MO502427404Medicaid
MO000011254Medicare PIN