Provider Demographics
NPI:1396746624
Name:SOUTHWEST CONTEMPORARY WOMEN'S CARE, PC
Entity type:Organization
Organization Name:SOUTHWEST CONTEMPORARY WOMEN'S CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-505-4258
Mailing Address - Street 1:2545 W FRYE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-275-8346
Practice Address - Street 1:2545 W FRYE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6273
Practice Address - Country:US
Practice Address - Phone:480-505-4258
Practice Address - Fax:480-275-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ236921Medicaid
AZZWMBFRMedicare PIN