Organization
SOUTHWEST GENERAL MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER WAGNER (EXECUTIVE DIRECTOR)
(440) 816-4906
Entity
Organization
Contact information
Practice address
15900 SNOW RD, BROOK PARK, OH 44142-2859
(216) 676-1234
(440) 816-6438
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-0001
(440) 816-5390
(440) 816-6438
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2238144
—
OH
05
—
2692466
—
OH
Enumeration date
09/06/2007
Last updated
02/28/2019
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