Healthcare Provider Details

I. General information

NPI: 1427347566
Provider Name (Legal Business Name): FAMILY & WOMEN'S HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 CURTIS DR STE A
WINAMAC IN
46996-8818
US

IV. Provider business mailing address

2418 CURTIS DR STE A
WINAMAC IN
46996-8818
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-3835
  • Fax: 574-946-4710
Mailing address:
  • Phone: 574-946-3835
  • Fax: 574-946-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057944A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number71000039A
License Number StateIN

VIII. Authorized Official

Name: CLINTON KAUFFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 574-946-3835