Provider Demographics
NPI:1508865965
Name:FAYETTEVILLE WOMEN'S CLINIC
Entity Type:Organization
Organization Name:FAYETTEVILLE WOMEN'S CLINIC
Other - Org Name:WILLIAM F. HARRISON
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:479-442-8166
Mailing Address - Street 1:1011 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2012
Mailing Address - Country:US
Mailing Address - Phone:479-442-8166
Mailing Address - Fax:479-442-0360
Practice Address - Street 1:1011 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-2012
Practice Address - Country:US
Practice Address - Phone:479-442-8166
Practice Address - Fax:479-442-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4206207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty