Active NPI
Woman'S Clinic, a Professional Association
- Rural Health Clinic/Center
- Clarksdale, MS
National Provider Identifier
1477898112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- WOMAN'S CLINIC, A PROFESSIONAL ASSOCIATION
- Practice address
- 2000 N State St
Clarksdale, MS 38614-6100 - Phone
- (662) 627-7361
- Fax
- (662) 627-4793
- NPI assigned
- Dec 6, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kushna K Damallie, MD
- Title
- President
- Phone
- (662) 627-7361
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | |||
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
2000 N State St
Clarksdale, MS 38614-6100
Mailing address
2000 N State St
Clarksdale, MS 38614-6100
Phone (662) 627-7361
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08321779 | Medicaid | MS | |
| 258977 | Other | RHC MEDICARE |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354752000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1576108800000",
"number": "1477898112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 N STATE ST",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386146100",
"telephone_number": "662-627-7361",
"fax_number": "662-627-4793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 N STATE ST",
"city": "CLARKSDALE",
"state": "MS",
"postal_code": "386146100",
"telephone_number": "662-627-7361",
"fax_number": "662-627-4793"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WOMAN'S CLINIC, A PROFESSIONAL ASSOCIATION",
"organizational_subpart": "NO",
"enumeration_date": "2012-12-06",
"last_updated": "2019-12-12",
"certification_date": "2019-12-12",
"status": "A",
"authorized_official_last_name": "DAMALLIE",
"authorized_official_first_name": "KUSHNA",
"authorized_official_middle_name": "K",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "662-627-7361",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08321779",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RHC MEDICARE",
"identifier": "258977",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksdale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.