Organization
WOMANS CLINIC, A PROFESSIONAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KUSHNA K DAMALLIE MD (PRESIDENT)
(662) 627-7361
Entity
Organization
Contact information
Practice address
2000 N STATE ST, CLARKSDALE, MS 38614-6100
(662) 627-7361
(662) 627-1158
Mailing address
2000 N STATE ST, CLARKSDALE, MS 38614-6100
(662) 627-7361
(662) 627-1158
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
MS
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08321779
—
MS
01
—
109754002
ARK MEDICAID GROUP NUMBER
MS
01
—
8P026
ARK BCBS GROUP NUMBER
MS
Enumeration date
08/24/2005
Last updated
12/12/2019
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