1356612154 NPI number — SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356612154 NPI number — SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356612154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10525 EMERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WISE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24293-6641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-328-2968
Provider Business Mailing Address Fax Number:
276-565-2427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 CALLAHAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPALACHIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24216-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-565-2425
Provider Business Practice Location Address Fax Number:
276-565-2427
Provider Enumeration Date:
01/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CARTAGENA
Authorized Official First Name:
RODOLFO
Authorized Official Middle Name:
JS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
276-565-2425

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  0101028013 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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