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General NPI Number Information
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NPI Number | 1336417831
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Entity Type | Organization
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Legal Business Name | WOMEN' S AND FAMILY CARE DBA GTC RESEARCH
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 21624 MIDLAND DR
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City | SHAWNEE
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State | KS
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Zip | 66218-9064
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Country | US
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Telephone | 913-643-0075
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Fax | 913-643-0077
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Provider Business Mailing Address
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Address Line | 21624 MIDLAND DR
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City | SHAWNEE
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State | KS
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Zip | 66218-9064
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Country | US
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Telephone | 913-643-0075
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Fax | 913-643-0077
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. TRACY A CLARK
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Credential | ARNP
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Telephone | 913-643-0075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 04-23518
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License Number State | KS
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