Provider Demographics
NPI:1962659508
Name:CLINIC FOR WOMEN PA
Entity Type:Organization
Organization Name:CLINIC FOR WOMEN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-7420
Mailing Address - Street 1:910 ADAMS ST SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3730
Mailing Address - Country:US
Mailing Address - Phone:256-533-7420
Mailing Address - Fax:256-536-4109
Practice Address - Street 1:250 CHATEAU DR SW
Practice Address - Street 2:SUITE 145
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6436
Practice Address - Country:US
Practice Address - Phone:256-533-7420
Practice Address - Fax:256-882-7858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINIC FOR WOMEN PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL32719OtherMEDICARE
AL32722OtherMEDICARE
AL32723OtherMEDICARE
AL32724OtherMEDICARE
AL78543OtherMEDICARE