Provider Demographics
NPI:1750475596
Name:THE WOMEN'S PAVILION, PSC
Entity Type:Organization
Organization Name:THE WOMEN'S PAVILION, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-926-3700
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLDG B STE 201
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-926-3700
Mailing Address - Fax:270-926-2114
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG B STE 201
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-926-3700
Practice Address - Fax:270-926-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH00745Medicare UPIN
KY504409Medicare PIN
KYC73904Medicare UPIN