Healthcare Provider Details

I. General information

NPI: 1134201957
Provider Name (Legal Business Name): WOMENS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E BROADWAY SUITE 108
JACKSON WY
83001-5550
US

IV. Provider business mailing address

PO BOX 14230
JACKSON WY
83002-4230
US

V. Phone/Fax

Practice location:
  • Phone: 307-734-1313
  • Fax: 307-734-0314
Mailing address:
  • Phone: 307-734-1313
  • Fax: 307-734-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: S DOUGLAS GEORGE
Title or Position: OWNER
Credential: MD
Phone: 307-734-1313