Provider Demographics
NPI:1053520502
Name:WOMEN'S CLINIC OF ALEXANDRIA LLP
Entity type:Organization
Organization Name:WOMEN'S CLINIC OF ALEXANDRIA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:JR
Authorized Official - Phone:318-443-6336
Mailing Address - Street 1:501 MEDICAL CENTER DRIVE
Mailing Address - Street 2:BOX 30114
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:71301-8124
Mailing Address - Country:US
Mailing Address - Phone:318-443-6336
Mailing Address - Fax:318-445-1597
Practice Address - Street 1:501 MEDICAL CENTER DRIVE
Practice Address - Street 2:STE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-443-6336
Practice Address - Fax:318-445-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171263Medicaid