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General NPI Number Information
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NPI Number | 1982884821
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Entity Type | Organization
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Legal Business Name | FOREST PHYSICIANS FOR WOMEN PC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1787 W LEE HWY
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City | WYTHEVILLE
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State | VA
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Zip | 24382-1437
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Country | US
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Telephone | 276-228-3355
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Fax | 276-228-6665
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Provider Business Mailing Address
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Address Line | PO BOX 652
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City | WYTHEVILLE
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State | VA
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Zip | 24382-0652
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Country | US
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Telephone | 276-228-3355
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Fax | 276-228-6665
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. DANIEL L KILGORE
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Credential |
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Telephone | 276-228-3355
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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 | 0101035671
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License Number State | VA
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