MEDICARE: OB & GYN WOMEN'S GROUP PA

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	174400000X	Specialist	C5352	AR

General Provider Information

NPI Number	:	1629193875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OB & GYN WOMEN'S GROUP PA

Provider Business Mailing Address
First Line	:	PO BOX 3507
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72913-3507
Country	:	US
Telephone Number	:	475-785-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7303 ROGERS AVE
Second Line	:	SUITE 302
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4165
Country	:	US
Telephone Number	:	475-785-2111
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID BRUCE GLOVER
Credential	:	M.D.
Telephone Number	:	479-785-2111

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	01/02/2008

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