Provider Demographics
NPI:1487789152
Name:A WOMANS LIFE FAMILY HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:A WOMANS LIFE FAMILY HEALTH CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:573-334-7006
Mailing Address - Street 1:1435 N MOUNT AUBURN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2171
Mailing Address - Country:US
Mailing Address - Phone:573-334-7006
Mailing Address - Fax:573-334-7090
Practice Address - Street 1:1435 N MOUNT AUBURN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-334-7006
Practice Address - Fax:573-334-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO126562363LF0000X
MO119283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595400003Medicaid
MO263912Medicare Oscar/Certification
MOA11684Medicare UPIN
MO595400003Medicaid
MOP53604Medicare UPIN