Provider Demographics
NPI:1861794505
Name:RENEW WOMANCARE LLC
Entity type:Organization
Organization Name:RENEW WOMANCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-994-8194
Mailing Address - Street 1:PO BOX 827
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0827
Mailing Address - Country:US
Mailing Address - Phone:541-614-0314
Mailing Address - Fax:
Practice Address - Street 1:2937 NW HIGHWAY 101
Practice Address - Street 2:UNIT A
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4442
Practice Address - Country:US
Practice Address - Phone:541-614-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18043174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty