Provider Demographics
NPI:1386738201
Name:LIFES CYCLE WOMENS CARE PC
Entity type:Organization
Organization Name:LIFES CYCLE WOMENS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-221-7500
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402
Mailing Address - Country:US
Mailing Address - Phone:580-221-7500
Mailing Address - Fax:580-490-9841
Practice Address - Street 1:970 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-221-7500
Practice Address - Fax:580-490-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522465Medicare PIN