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NPI Code Detail

MEDICARE: WOMANS CLINIC, A PROFESSIONAL ASSOCIATION

MEDICARE: WOMANS CLINIC, A PROFESSIONAL ASSOCIATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistMS
2261QR1300XRural Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38P026OTHERMSARK BCBS GROUP NUMBER

General Provider Information

NPI Number : 1043203136
Entity Type Code : Organization
Provider Name (Legal Business Name) : WOMANS CLINIC, A PROFESSIONAL ASSOCIATION
Provider Business Mailing Address
First Line : 2000 N STATE ST
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-6100
Country : US
Telephone Number : 662-627-7361
Fax Number : 662-627-1158
Provider Business Practice Location Address
First Line : 2000 N STATE ST
Second Line :
City : CLARKSDALE
State : MS
Zip : 38614-6100
Country : US
Telephone Number : 662-627-7361
Fax Number : 662-627-1158
Authorized Official
Title or Position : PRESIDENT
Name : DR. KUSHNA K DAMALLIE
Credential : MD
Telephone Number : 662-627-7361
Provider Enumeration Date : 08/24/2005
Last Update Date : 12/12/2019

Similar Medicare Providers

1669248522 — LAUREN ELISE AGOSTINELLI WHNP-BC
Practice Location Address:
2000 N STATE ST
CLARKSDALE, MS
38614-6100
Practice Phone: 662-627-7361
Practice Fax:
1861488215 — DR. KUSHNA K DAMALLIE MD
Practice Location Address:
2000 N STATE ST
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1982690061 — MS. LINDA D WRIGHT RNC
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CLARKSDALE, MS
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1730104928 — DR. DELPHIA M HORD MD
Practice Location Address:
2000 N STATE ST
CLARKSDALE, MS
38614-6100
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1306958178 — RCG MISSISSIPPI, INC.
Practice Location Address:
2010 N STATE ST
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1629293113 — FRANK T. MARASCALCO, M.D., P.A.
Practice Location Address:
2000 N STATE ST
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38614-6100
Practice Phone: 662-627-7361
Practice Fax: 662-627-1158

Directions to “WOMANS CLINIC, A PROFESSIONAL ASSOCIATION ” Practice Location

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