=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629565072
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS CENTER FOR HEALTH AND WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2018
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 ROGERS AVE
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-459-6528
-----------------------------------------------------
Fax | 479-222-6893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 ROGERS AVE
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901-4232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-459-6528
-----------------------------------------------------
Fax | 479-222-6893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | THOMAS REYNOLDS WOOD
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 479-431-7085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | E5219
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------