Provider Demographics
NPI:1962456574
Name:WOMANS CLINIC A PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:WOMANS CLINIC A PROFESSIONAL ASSOCIATION
Other - Org Name:WOMANS CLINIC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-422-4642
Mailing Address - Street 1:244 COATSLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3948
Mailing Address - Country:US
Mailing Address - Phone:731-422-4642
Mailing Address - Fax:731-422-2277
Practice Address - Street 1:244 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3948
Practice Address - Country:US
Practice Address - Phone:731-422-4642
Practice Address - Fax:731-422-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3383748Medicaid
TN3383748Medicaid