Provider Demographics
NPI:1417217480
Name:SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA, PLLC
Entity Type:Organization
Organization Name:SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-565-2425
Mailing Address - Street 1:127 CALLAHAN AVE
Mailing Address - Street 2:
Mailing Address - City:APPALACHIA
Mailing Address - State:VA
Mailing Address - Zip Code:24216-1203
Mailing Address - Country:US
Mailing Address - Phone:276-565-2425
Mailing Address - Fax:276-565-2427
Practice Address - Street 1:127 CALLAHAN AVE
Practice Address - Street 2:
Practice Address - City:APPALACHIA
Practice Address - State:VA
Practice Address - Zip Code:24216-1203
Practice Address - Country:US
Practice Address - Phone:276-565-2425
Practice Address - Fax:276-565-2427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODOLFO CARTAGENA, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028013261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720016389Medicaid
VAB06159Medicare UPIN