Provider Demographics
NPI:1174579163
Name:WOMENS HEALTH SPECIALIST OF APPALACHIA INC
Entity type:Organization
Organization Name:WOMENS HEALTH SPECIALIST OF APPALACHIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-889-6160
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0265
Mailing Address - Country:US
Mailing Address - Phone:606-889-6160
Mailing Address - Fax:606-889-6161
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:SUITE 2127
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6160
Practice Address - Fax:606-889-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933913Medicaid
KY65933913Medicaid