Healthcare Provider Details

I. General information

NPI: 1760585988
Provider Name (Legal Business Name): ELIZABETHTOWN PHYSICIANS FOR WOMEN,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WOODLAND DR
ELIZABETHTOWN KY
42701-2749
US

IV. Provider business mailing address

1115 WOODLAND DR
ELIZABETHTOWN KY
42701-2749
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-5963
  • Fax: 270-769-9051
Mailing address:
  • Phone: 270-769-5963
  • Fax: 270-769-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5052P
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1802M
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY RICHARDSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-769-5963