MEDICARE: CANTON WOMEN'S CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2274716	OTHER		AETNA

General Provider Information

NPI Number	:	1386691921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON WOMEN'S CENTER INC

Provider Business Mailing Address
First Line	:	6555 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7265
Country	:	US
Telephone Number	:	330-966-9090
Fax Number	:	330-966-9030

Provider Business Practice Location Address
First Line	:	6555 FRANK AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7265
Country	:	US
Telephone Number	:	330-966-9090
Fax Number	:	330-966-9030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JORGE RAUL ROMERO
Credential	:	MD
Telephone Number	:	330-966-9090

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

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Directions to “CANTON WOMEN'S CENTER INC ” Practice Location

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