Provider Demographics
NPI:1356612154
Name:SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA
Entity type:Organization
Organization Name:SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:JS
Authorized Official - Last Name:CARTAGENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-565-2425
Mailing Address - Street 1:10525 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-6641
Mailing Address - Country:US
Mailing Address - Phone:276-328-2968
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028013261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty