Provider Demographics
NPI:1881641751
Name:SOUTHWEST WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:SOUTHWEST WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:520-836-0933
Mailing Address - Street 1:1829 E MCMURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5404
Mailing Address - Country:US
Mailing Address - Phone:520-836-0933
Mailing Address - Fax:520-836-6500
Practice Address - Street 1:1829 E MCMURRAY BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5404
Practice Address - Country:US
Practice Address - Phone:520-836-0933
Practice Address - Fax:520-836-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27066207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449183Medicaid
F49679Medicare UPIN
AZZ92712Medicare PIN