Provider Demographics
NPI:1922058213
Name:CENTRAL CLINIC FOR WOMEN, P. A.
Entity Type:Organization
Organization Name:CENTRAL CLINIC FOR WOMEN, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WIEDOWER-EBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-227-5885
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 500
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6341
Practice Address - Country:US
Practice Address - Phone:501-227-5885
Practice Address - Fax:501-227-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121648002Medicaid