Provider Demographics
NPI:1568451565
Name:SOUTHWEST FERTILITY CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHWEST FERTILITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:2850 KEAGY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7458
Mailing Address - Country:US
Mailing Address - Phone:540-776-4989
Mailing Address - Fax:540-776-4986
Practice Address - Street 1:2850 KEAGY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7458
Practice Address - Country:US
Practice Address - Phone:540-776-4989
Practice Address - Fax:540-776-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08948Medicare ID - Type Unspecified