Provider Demographics
NPI:1841398401
Name:WOMAN'S CLINIC, INC
Entity Type:Organization
Organization Name:WOMAN'S CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-887-5500
Mailing Address - Street 1:1135 E LAKEWOOD ST
Mailing Address - Street 2:SUITE112
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2434
Mailing Address - Country:US
Mailing Address - Phone:417-887-5500
Mailing Address - Fax:417-883-8964
Practice Address - Street 1:1135 E LAKEWOOD ST
Practice Address - Street 2:SUITE112
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2434
Practice Address - Country:US
Practice Address - Phone:417-887-5500
Practice Address - Fax:417-883-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507847101Medicaid
MO000013188Medicare PIN