MEDICARE: JACKSON HOLE CARE FOR WOMEN

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1184264046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON HOLE CARE FOR WOMEN

Provider Business Mailing Address
First Line	:	PO BOX 12740
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-2740
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S CACHE ST
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-201-1489
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY GIRLING
Credential	:	MD
Telephone Number	:	307-201-1489

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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Directions to “JACKSON HOLE CARE FOR WOMEN ” Practice Location

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