Organization
SOUTHWEST GENERAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER WAGNER (EXECUTIVE DIRECTOR)
(440) 816-4906
Entity
Organization
Contact information
Practice address
18697 BAGLEY RD, CLEVELAND, OH 44130-3417
(440) 816-8200
(440) 816-8197
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-8269
(440) 289-2025
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50005004
OH
Other
Enumeration date
03/09/2017
Last updated
02/28/2019
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