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General NPI Number Information
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NPI Number | 1881346658
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Entity Type | Organization
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Legal Business Name | CHILLICOTHE WOMENS CLINIC LLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 861 FAIRWAY DR
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-3673
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Country | US
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Telephone | 913-680-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 4566 STATE HIGHWAY 190
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City | CHILLICOTHEE
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State | MO
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Zip | 64601-5313
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Country | US
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Telephone | 913-680-9830
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. YULIA PENISTON
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Credential | DO
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Telephone | 913-680-9830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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