Provider Demographics
NPI:1427617406
Name:GYNECOLOGY SPECIALISTS, LLC
Entity type:Organization
Organization Name:GYNECOLOGY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-2221
Mailing Address - Street 1:1605 E BROADWAY STE 260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8044
Mailing Address - Country:US
Mailing Address - Phone:573-442-2221
Mailing Address - Fax:573-449-8646
Practice Address - Street 1:1605 E BROADWAY STE 260
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8044
Practice Address - Country:US
Practice Address - Phone:573-442-2221
Practice Address - Fax:573-449-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205887912Medicaid