Provider Demographics
NPI:1447601968
Name:WOMENS HEALTH AND ONCOLOGY SERVICES
Entity Type:Organization
Organization Name:WOMENS HEALTH AND ONCOLOGY SERVICES
Other - Org Name:CRAIG SHIELDS SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HUNN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:385-347-5450
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:STE 300 B
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:385-347-5450
Mailing Address - Fax:801-456-8408
Practice Address - Street 1:1140 E. 3900 S.
Practice Address - Street 2:STE 300 B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3318
Practice Address - Country:US
Practice Address - Phone:385-347-5450
Practice Address - Fax:801-456-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6019946125207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000086600Medicare UPIN