Provider Demographics
NPI:1508030081
Name:WOMEN'S HEALTH CENTER OF SWVA LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CENTER OF SWVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TEDRICK
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-237-7760
Mailing Address - Street 1:101 1ST ST NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-5603
Mailing Address - Country:US
Mailing Address - Phone:540-980-9170
Mailing Address - Fax:540-980-9175
Practice Address - Street 1:101 1ST ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5603
Practice Address - Country:US
Practice Address - Phone:540-980-9170
Practice Address - Fax:540-980-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508030081Medicaid
VA1508030081Medicaid