Provider Demographics
NPI:1881346658
Name:CHILLICOTHE WOMENS CLINIC LLC
Entity type:Organization
Organization Name:CHILLICOTHE WOMENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENISTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-680-9830
Mailing Address - Street 1:4566 STATE HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-5313
Mailing Address - Country:US
Mailing Address - Phone:913-680-9830
Mailing Address - Fax:
Practice Address - Street 1:861 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3673
Practice Address - Country:US
Practice Address - Phone:913-680-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty