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General NPI Number Information
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NPI Number | 1578714770
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Entity Type | Organization
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Legal Business Name | GENERATIONS WOMEN'S CLINIC, PLLC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 36 PROFESSIONAL PLZ
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City | REXBURG
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State | ID
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Zip | 83440-2049
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Country | US
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Telephone | 208-656-8864
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Fax | 208-656-8877
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Provider Business Mailing Address
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Address Line | 36 PROFESSIONAL PLZ
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City | REXBURG
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State | ID
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Zip | 83440-2049
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Country | US
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Telephone | 208-656-8864
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Fax | 208-656-8877
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GARY LOVELL
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Credential | MD
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Telephone | 208-656-8864
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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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