Provider Demographics
NPI:1356398945
Name:SOUTHTOWN WOMENS CLINIC LLC
Entity type:Organization
Organization Name:SOUTHTOWN WOMENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUENY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-3131
Mailing Address - Street 1:6400 PROSPECT AVE
Mailing Address - Street 2:SUITE 546
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1100
Mailing Address - Country:US
Mailing Address - Phone:816-333-3131
Mailing Address - Fax:816-333-2295
Practice Address - Street 1:6400 PROSPECT AVE
Practice Address - Street 2:SUITE 546
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1100
Practice Address - Country:US
Practice Address - Phone:816-333-3131
Practice Address - Fax:816-333-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100643340AMedicaid
MO509274700Medicaid
MOP610000Medicare PIN
MO509274700Medicaid