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General NPI Number Information
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NPI Number | 1083940084
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Entity Type | Organization
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Legal Business Name | LAUREL CENTER FOR WOMEN, LLC
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 10 ENTERPRISE BLVD STE 210
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City | GREENVILLE
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State | SC
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Zip | 29615-3554
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Country | US
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Telephone | 864-277-5645
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Fax | 864-277-9427
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Provider Business Mailing Address
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Address Line | 10 ENTERPRISE BLVD STE 210
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City | GREENVILLE
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State | SC
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Zip | 29615-3554
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Country | US
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Telephone | 864-277-5645
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Fax | 864-277-9427
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Authorized Official
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Title or Position | MEMBER
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Name | DR. THOMAS M ROESCH
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Credential | MD
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Telephone | 864-277-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 14872
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License Number State | SC
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