Healthcare Provider Details

I. General information

NPI: 1801855150
Provider Name (Legal Business Name): WILLOWBROOK WOMENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 MARIE LANGDON DR STE 4
MANCHESTER KY
40962-6353
US

IV. Provider business mailing address

94 MARIE LANGDON DR STE 4
MANCHESTER KY
40962-6353
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-5104
  • Fax: 606-598-1040
Mailing address:
  • Phone: 606-598-5104
  • Fax: 606-598-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number39787
License Number StateKY

VIII. Authorized Official

Name: MR. CHARLES E WHITING
Title or Position: OB/GYN
Credential: M.D.
Phone: 606-598-5104