Healthcare Provider Details

I. General information

NPI: 1255326245
Provider Name (Legal Business Name): SOUTHWEST VIRGINIA PHYSICIANS FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 WHITE ST NE
ABINGDON VA
24210-2913
US

IV. Provider business mailing address

277 WHITE ST NE
ABINGDON VA
24210-2913
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-4335
  • Fax: 276-628-3195
Mailing address:
  • Phone: 276-628-4335
  • Fax: 276-628-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY WAYNE LAVIGNE
Title or Position: OWNER
Credential: M.D.
Phone: 276-628-4335