Provider Demographics
NPI:1831247345
Name:SOUTHERN WOMEN'S CARE OBSTETRICS & GYNECOLOGY, PLLC
Entity type:Organization
Organization Name:SOUTHERN WOMEN'S CARE OBSTETRICS & GYNECOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-932-4525
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42782-0127
Mailing Address - Country:US
Mailing Address - Phone:270-932-4525
Mailing Address - Fax:270-932-2000
Practice Address - Street 1:67 KINGSWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9647
Practice Address - Country:US
Practice Address - Phone:270-932-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7060Medicare ID - Type Unspecified