=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801131404
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLAND CENTER FOR WOMEN'S HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2012
-----------------------------------------------------
Last Update Date | 12/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 CATALINA DR
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-482-3327
-----------------------------------------------------
Fax | 541-482-7376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 CATALINA DR
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97520-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-482-3327
-----------------------------------------------------
Fax | 541-482-7376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YVONNE SUZANNE FRIED
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 541-482-3327
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | MD18034
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------