MEDICARE: WOMENS HEALTH AND ONCOLOGY SERVICES

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	207VX0201X	Gynecologic Oncology Physician	6019946125	UT

General Provider Information

NPI Number	:	1447601968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS HEALTH AND ONCOLOGY SERVICES

Provider Business Mailing Address
First Line	:	1140 E 3900 S
Second Line	:	STE 300 B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1228
Country	:	US
Telephone Number	:	385-347-5450
Fax Number	:	801-456-8408

Provider Business Practice Location Address
First Line	:	1140 E. 3900 S.
Second Line	:	STE 300 B
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-3318
Country	:	US
Telephone Number	:	385-347-5450
Fax Number	:	801-456-8408

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JESSICA RAE HUNN
Credential	:	OWNER
Telephone Number	:	385-347-5450

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	02/15/2017

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