Provider Demographics
NPI:1912073784
Name:WOMENS HEALTH ASSOCIATES OF SOUTHERN ILLINOIS, S. C.
Entity Type:Organization
Organization Name:WOMENS HEALTH ASSOCIATES OF SOUTHERN ILLINOIS, S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMONTON-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-242-4162
Mailing Address - Street 1:PO BOX 1614
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0032
Mailing Address - Country:US
Mailing Address - Phone:618-242-4162
Mailing Address - Fax:618-242-8445
Practice Address - Street 1:1708 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-4309
Practice Address - Country:US
Practice Address - Phone:618-242-4162
Practice Address - Fax:618-242-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH3404OtherRAILROAD MEDICARE
ILCH3404OtherRAILROAD MEDICARE