Healthcare Provider Details

I. General information

NPI: 1922202829
Provider Name (Legal Business Name): ISIS WOMEN'S CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR SUITE 105
MARTINSVILLE VA
24112-1945
US

IV. Provider business mailing address

PO BOX 4146
MARTINSVILLE VA
24115-4146
US

V. Phone/Fax

Practice location:
  • Phone: 276-634-0050
  • Fax: 276-634-0040
Mailing address:
  • Phone: 276-634-0050
  • Fax: 276-634-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101241213
License Number StateVA

VIII. Authorized Official

Name: DR. KIMBERLY L MATCHETT
Title or Position: OWNER
Credential: MD
Phone: 276-634-0050