Provider Demographics
NPI:1043486152
Name:WYTHE PHYSICIANS FOR WOMEN, PLLC
Entity Type:Organization
Organization Name:WYTHE PHYSICIANS FOR WOMEN, PLLC
Other - Org Name:WYTHE PHYSICIANS FOR WOMEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-228-2008
Mailing Address - Street 1:140 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-228-2008
Mailing Address - Fax:276-228-5598
Practice Address - Street 1:140 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-2008
Practice Address - Fax:276-228-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043486152Medicaid
VAC10506Medicare PIN