Provider Demographics
NPI:1083064315
Name:ENCORE OB GYN CENTER OF SOUTHWEST VIRGINIA LLC
Entity Type:Organization
Organization Name:ENCORE OB GYN CENTER OF SOUTHWEST VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-239-1981
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505-0239
Mailing Address - Country:US
Mailing Address - Phone:800-779-0902
Mailing Address - Fax:800-507-8011
Practice Address - Street 1:825 DAVIS ST
Practice Address - Street 2:SUITE C
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7009
Practice Address - Country:US
Practice Address - Phone:540-251-0980
Practice Address - Fax:540-251-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF980Medicare PIN