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General NPI Number Information
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NPI Number | 1134201957
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTH CENTER
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 555 E BROADWAY SUITE 108
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City | JACKSON
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State | WY
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Zip | 83001-5550
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Country | US
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Telephone | 307-734-1313
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Fax | 307-734-0314
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Provider Business Mailing Address
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Address Line | PO BOX 14230
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City | JACKSON
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State | WY
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Zip | 83002-4230
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Country | US
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Telephone | 307-734-1313
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Fax | 307-734-0314
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Authorized Official
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Title or Position | OWNER
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Name | S DOUGLAS GEORGE
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Credential | MD
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Telephone | 307-734-1313
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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