Provider Demographics
NPI:1760476063
Name:WOMENS CLINIC ASSOCIATES PA
Entity Type:Organization
Organization Name:WOMENS CLINIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LORENZETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-788-9797
Mailing Address - Street 1:3550 S 4TH ST
Mailing Address - Street 2:STE 150
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5071
Mailing Address - Country:US
Mailing Address - Phone:913-788-9797
Mailing Address - Fax:913-788-5263
Practice Address - Street 1:3550 S 4TH ST
Practice Address - Street 2:STE 150
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5071
Practice Address - Country:US
Practice Address - Phone:913-788-9797
Practice Address - Fax:913-788-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200268690AMedicaid
MOB290000Medicare ID - Type Unspecified
KS016149Medicare ID - Type Unspecified