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General NPI Number Information
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NPI Number | 1205985967
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Entity Type | Organization
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Legal Business Name | SOUTHWEST GENERAL MEDICAL GROUP, INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 18780 BAGLEY RD # 100
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City | CLEVELAND
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State | OH
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Zip | 44130-3304
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Country | US
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Telephone | 440-816-2850
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 638269
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 440-816-2850
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HEATHER WAGNER
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Credential |
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Telephone | 440-816-4906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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