MEDICARE: WOMENCARE INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

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	:	1447741236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENCARE INC

Provider Business Mailing Address
First Line	:	97 GREAT TEAYS BLVD STE 6
Second Line	:
City	:	SCOTT DEPOT
State	:	WV
Zip	:	25560-9816
Country	:	US
Telephone Number	:	304-757-6999
Fax Number	:	304-201-5019

Provider Business Practice Location Address
First Line	:	1500 GREENBRIER ST # 160
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1007
Country	:	US
Telephone Number	:	304-757-6999
Fax Number	:	304-201-5019

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	JULIE DIANNE RAY
Credential	:
Telephone Number	:	304-757-6999

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/24/2022

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Directions to “WOMENCARE INC ” Practice Location

Language	Start Address	Practice Location

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