Provider Demographics
NPI:1962416792
Name:WOMEN'S CARE CENTER PLLC
Entity type:Organization
Organization Name:WOMEN'S CARE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSITANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-278-0363
Mailing Address - Street 1:1720 NICHOLASVILLE RD.
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-278-0363
Mailing Address - Fax:859-278-5317
Practice Address - Street 1:1720 NICHOLASVILLE RD.
Practice Address - Street 2:SUITE 402
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-0363
Practice Address - Fax:859-278-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
KYGUIL-0427-6664363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928632Medicaid
KY65928632Medicaid