Provider Demographics
NPI:1265588990
Name:WOMENS HEALTH CLINIC OF CYNTHIANA
Entity type:Organization
Organization Name:WOMENS HEALTH CLINIC OF CYNTHIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-234-9955
Mailing Address - Street 1:1210 KY HWY 36 EAST
Mailing Address - Street 2:SUITE G4
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031
Mailing Address - Country:US
Mailing Address - Phone:859-234-9955
Mailing Address - Fax:859-234-9959
Practice Address - Street 1:1210 KY HWY 36 EAST
Practice Address - Street 2:SUITE G4
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031
Practice Address - Country:US
Practice Address - Phone:859-234-9955
Practice Address - Fax:859-234-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1265588990OtherNPI WOMEN'S HEALTH CLINIC
KY65946329Medicaid
KY1104927011OtherNPI DR. MARY C. BELL
KY1982612354OtherNPI DR. DEREK J CLARKE
KY65946329Medicaid