Basic Information
| Provider Information | |||||||||
| NPI: | 1023176393 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB-GYN SPECIALISTS OF NORTHERN KY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593412510 | ||||||||
| FaxNumber: | 8595782004 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593412510 | ||||||||
| FaxNumber: | 8595782004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEVINGTON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8593412510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | CMPE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.