Healthcare Provider Details

I. General information

NPI: 1356853592
Provider Name (Legal Business Name): WHOLE WOMAN'S HEALTH ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 COMMONWEALTH DR
CHARLOTTESVILLE VA
22901-1637
US

IV. Provider business mailing address

1001 E MARKET ST STE 200
CHARLOTTESVILLE VA
22902-5381
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-4888
  • Fax: 888-724-3239
Mailing address:
  • Phone: 434-202-8818
  • Fax: 888-724-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA E SMITH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 888-737-9615