Provider Demographics
NPI:1134201957
Name:WOMENS HEALTH CENTER
Entity type:Organization
Organization Name:WOMENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-734-1313
Mailing Address - Street 1:PO BOX 14230
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-4230
Mailing Address - Country:US
Mailing Address - Phone:307-734-1313
Mailing Address - Fax:307-734-0314
Practice Address - Street 1:555 E BROADWAY SUITE 108
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-5550
Practice Address - Country:US
Practice Address - Phone:307-734-1313
Practice Address - Fax:307-734-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113684400Medicaid
WYW307735Medicare ID - Type UnspecifiedMEDICARE