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
7265 OLD OAK BLVD, CLEVELAND, OH 44130-3342
(440) 816-5790
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-0001
(440) 816-5790
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2238144
—
OH
05
—
2238180
—
OH
01
—
CA1078
RAILROAD MEDICARE
OH
01
—
DA4203
RAILROAD MEDICARE
OH
Enumeration date
01/10/2007
Last updated
05/11/2020
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