MEDICARE: WOMEN FIRST OB GYN PLLC

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	176B00000X	Midwife	108316	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376855023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN FIRST OB GYN PLLC

Provider Business Mailing Address
First Line	:	1177 NORTH ROAD STREET
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4472
Country	:	US
Telephone Number	:	252-338-9080
Fax Number	:	252-338-6712

Provider Business Practice Location Address
First Line	:	1177 NORTH ROAD STREET
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4472
Country	:	US
Telephone Number	:	252-338-9080
Fax Number	:	252-338-6712

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	YVONNE MCLAURIN MOORE
Credential	:	RN, BSN
Telephone Number	:	252-338-9080

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	07/22/2010

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