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General NPI Number Information
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NPI Number | 1982776134
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Entity Type | Organization
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Legal Business Name | MORNING STAR WOMEN HEALTH CENTER INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 01/26/2010
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Provider Practice Location Address
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Address Line | 422 PEACOCK ST P. O. BO 190
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City | AHOSKIE
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State | NC
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Zip | 27910-3930
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Country | US
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Telephone | 252-332-8206
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Fax | 252-332-1623
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Provider Business Mailing Address
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Address Line | 422 PEACOCK ST PO BOX 190
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City | AHOSKIE
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State | NC
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Zip | 27910-3930
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Country | US
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Telephone | 252-332-8206
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Fax | 252-332-1623
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. RICKY LORENZO BROOKS
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Credential | M.D.
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Telephone | 252-332-8206
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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 | 31775
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License Number State | NC
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