Provider Demographics
NPI:1932269073
Name:SOUTHWEST WOMENS HEALTH P A
Entity Type:Organization
Organization Name:SOUTHWEST WOMENS HEALTH P A
Other - Org Name:REBECCA J SHODEN MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHODEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-247-8820
Mailing Address - Street 1:883 LEAD AVE SE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3644
Mailing Address - Country:US
Mailing Address - Phone:505-247-8820
Mailing Address - Fax:505-246-9421
Practice Address - Street 1:883 LEAD AVE SE
Practice Address - Street 2:STE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3644
Practice Address - Country:US
Practice Address - Phone:505-247-8820
Practice Address - Fax:505-246-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-111207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26963Medicaid
NME07884Medicare UPIN
NM400521075Medicare PIN