Provider Demographics
NPI:1932135159
Name:A WOMAN'S PLACE AT THE CLINIC FOR WOMEN, INC
Entity Type:Organization
Organization Name:A WOMAN'S PLACE AT THE CLINIC FOR WOMEN, INC
Other - Org Name:THE CLINIC FOR WOMEN, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-753-7060
Mailing Address - Street 1:4400 BROADWAY ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-753-7060
Mailing Address - Fax:816-753-2224
Practice Address - Street 1:4400 BROADWAY ST
Practice Address - Street 2:SUITE 409
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-753-7060
Practice Address - Fax:816-753-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505738807Medicaid
440000Medicare ID - Type Unspecified