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General NPI Number Information
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NPI Number | 1801855150
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Entity Type | Organization
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Legal Business Name | WILLOWBROOK WOMENS CENTER
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 94 MARIE LANGDON DR STE 4
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City | MANCHESTER
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State | KY
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Zip | 40962-6353
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Country | US
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Telephone | 606-598-5104
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Fax | 606-598-1040
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Provider Business Mailing Address
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Address Line | 94 MARIE LANGDON DR STE 4
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City | MANCHESTER
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State | KY
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Zip | 40962-6353
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Country | US
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Telephone | 606-598-5104
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Fax | 606-598-1040
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Authorized Official
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Title or Position | OB/GYN
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Name | MR. CHARLES E WHITING
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Credential | M.D.
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Telephone | 606-598-5104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 39787
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License Number State | KY
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