=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770841215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CV OB GYN WOMEN'S HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2012
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5882 S HOSPITAL DRIVE SUITE 1
-----------------------------------------------------
City | GLOBE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-425-8499
-----------------------------------------------------
Fax | 928-425-8706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5860 S HOSPITAL DR SUITE 102
-----------------------------------------------------
City | GLOBE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85501-9449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-425-3247
-----------------------------------------------------
Fax | 928-425-3859
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NEAL D JENSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-425-3261
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | H0126
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------