Basic Information
| Provider Information | |||||||||
| NPI: | 1770841215 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CV OB GYN WOMEN'S HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5860 S HOSPITAL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855019449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284253247 | ||||||||
| FaxNumber: | 9284253859 | ||||||||
| Practice Location | |||||||||
| Address1: | 5882 S HOSPITAL DRIVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GLOBE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284258499 | ||||||||
| FaxNumber: | 9284258706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9284253261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | H0126 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.