Provider Demographics
NPI:1467593624
Name:SOUTHWEST VA PHYSICIANS FOR WOMEN, INC
Entity Type:Organization
Organization Name:SOUTHWEST VA PHYSICIANS FOR WOMEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-1550
Mailing Address - Street 1:826 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7010
Mailing Address - Country:US
Mailing Address - Phone:540-951-1550
Mailing Address - Fax:540-951-7427
Practice Address - Street 1:826 DAVIS ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7010
Practice Address - Country:US
Practice Address - Phone:540-951-1550
Practice Address - Fax:540-951-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05125Medicare PIN
VAC05124Medicare PIN
VAC05123Medicare PIN