Provider Demographics
NPI:1922588821
Name:FREE WOMEN'S CENTER OF PULASKI COUNTY
Entity Type:Organization
Organization Name:FREE WOMEN'S CENTER OF PULASKI COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO (OB/GYN)
Authorized Official - Phone:573-774-4992
Mailing Address - Street 1:704 HISTORIC ROUTE 66 WEST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-8322
Mailing Address - Country:US
Mailing Address - Phone:573-774-4992
Mailing Address - Fax:573-774-4968
Practice Address - Street 1:704 HISTORIC ROUTE 66 WEST
Practice Address - Street 2:SUITE 106
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-8322
Practice Address - Country:US
Practice Address - Phone:573-774-4992
Practice Address - Fax:573-774-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013466261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center