Provider Demographics
NPI:1629193875
Name:OB & GYN WOMEN'S GROUP PA
Entity Type:Organization
Organization Name:OB & GYN WOMEN'S GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-785-2111
Mailing Address - Street 1:PO BOX 3507
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-3507
Mailing Address - Country:US
Mailing Address - Phone:475-785-2111
Mailing Address - Fax:
Practice Address - Street 1:7303 ROGERS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4165
Practice Address - Country:US
Practice Address - Phone:475-785-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC51867Medicare UPIN
AR5C067Medicare PIN