Healthcare Provider Details

I. General information

NPI: 1447433859
Provider Name (Legal Business Name): GENERATIONS WOMENS HEALTH S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 - 35TH AVENUE
MOLINE IL
61265
US

IV. Provider business mailing address

612 - 35TH AVENUE
MOLINE IL
61265-6176
US

V. Phone/Fax

Practice location:
  • Phone: 309-764-1133
  • Fax: 309-764-6769
Mailing address:
  • Phone: 309-764-1133
  • Fax: 309-764-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036 100979
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036 099463
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number042-005511
License Number StateIL

VIII. Authorized Official

Name: RHONDA L. FREED
Title or Position: PROVIDER/CO-OWNER
Credential: M.D.
Phone: 309-764-1133