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General NPI Number Information
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NPI Number | 1912073784
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTH ASSOCIATES OF SOUTHERN ILLINOIS, S. C.
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Dates
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Enumeration Date | 11/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1708 JEFFERSON AVE
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4309
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Country | US
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Telephone | 618-242-4162
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Fax | 618-242-8445
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Provider Business Mailing Address
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Address Line | PO BOX 1614
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City | MOUNT VERNON
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State | IL
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Zip | 62864-0032
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Country | US
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Telephone | 618-242-4162
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Fax | 618-242-8445
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LESLIE L SIMONTON-SMITH
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Credential | M.D.
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Telephone | 618-242-4162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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