MEDICARE: ALL WOMEN'S REGIONAL MEDICAL CENTER, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	TAP 8360	AZ

General Provider Information

NPI Number	:	1164881405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL WOMEN'S REGIONAL MEDICAL CENTER, PC

Provider Business Mailing Address
First Line	:	2500 CANYON RD
Second Line	:	STE A1
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 CANYON RD
Second Line	:	STE A1
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8624
Country	:	US
Telephone Number	:	928-704-4499
Fax Number	:	928-704-4949

Authorized Official
Title or Position	:	FOUNDER MD
Name	:	CHRISTINA GOLDSTEIN-CHARBONNEAU
Credential	:	D.O
Telephone Number	:	928-704-4499

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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