Provider Demographics
NPI:1770841215
Name:CV OB GYN WOMEN'S HEALTHCARE
Entity type:Organization
Organization Name:CV OB GYN WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-425-3261
Mailing Address - Street 1:5860 S HOSPITAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9449
Mailing Address - Country:US
Mailing Address - Phone:928-425-3247
Mailing Address - Fax:928-425-3859
Practice Address - Street 1:5882 S HOSPITAL DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-425-8499
Practice Address - Fax:928-425-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH0126207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty