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General NPI Number Information
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NPI Number | 1861794505
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Entity Type | Organization
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Legal Business Name | RENEW WOMANCARE LLC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 2937 NW HIGHWAY 101 UNIT A
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City | LINCOLN CITY
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State | OR
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Zip | 97367-4442
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Country | US
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Telephone | 541-614-0314
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 827
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City | NEOTSU
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State | OR
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Zip | 97364-0827
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Country | US
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Telephone | 541-614-0314
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DAN D KORT
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Credential | M.D
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Telephone | 541-994-8194
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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 | MD18043
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License Number State | OR
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