Provider Demographics
NPI:1255480513
Name:BARDSTOWN WOMEN'S CENTER PLLC
Entity type:Organization
Organization Name:BARDSTOWN WOMEN'S CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:DELACRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-348-7755
Mailing Address - Street 1:201 S.5TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-348-7755
Mailing Address - Fax:502-349-0815
Practice Address - Street 1:201 S. 5TH ST.
Practice Address - Street 2:SUITE 9
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-7755
Practice Address - Fax:502-349-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65929879Medicaid
KY65929879Medicaid
KY6199Medicare ID - Type Unspecified