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General NPI Number Information
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NPI Number | 1801947478
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Entity Type | Organization
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Legal Business Name | BRISTOL REGIONAL WOMEN'S CENTER
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2901 W STATE ST
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City | BRISTOL
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State | TN
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Zip | 37620-1718
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Country | US
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Telephone | 423-968-2182
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Fax | 423-968-7589
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Provider Business Mailing Address
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Address Line | 2901 W STATE ST
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City | BRISTOL
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State | TN
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Zip | 37620-1718
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Country | US
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Telephone | 423-968-2182
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Fax | 423-968-7589
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LEISA BOYLE
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Credential |
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Telephone | 423-968-2182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State | TN
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