Organization
OB-GYN WOMEN'S CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE PITUCH IMMESBERGER (ADMINISTRATIVE ASSISTANT)
(928) 514-8602
Entity
Organization
Contact information
Practice address
3003 HIGHWAY 95, SUITE 39, BULLHEAD CITY, AZ 86429
(928) 758-1010
(928) 758-1428
Mailing address
3003 HIGHWAY 95, SUITE 39, BULLHEAD CITY, AZ 86429
(928) 758-1010
(928) 758-1428
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
305S00000X
Point of Service
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145525
—
AZ
Enumeration date
06/21/2007
Last updated
10/29/2018
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