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General NPI Number Information
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NPI Number | 1730545690
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Entity Type | Organization
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Legal Business Name | MONUMENT WOMEN'S HEALTHCARE, LLC
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 610 25 RD
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City | GRAND JUNCTION
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State | CO
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Zip | 81505-1202
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Country | US
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Telephone | 970-628-6954
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23228
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City | GLADE PARK
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State | CO
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Zip | 81523-0228
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Country | US
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Telephone | 970-628-6954
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL WHITE
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Credential | M.D.
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Telephone | 970-628-6954
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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 | 0052262
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License Number State | CO
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