Basic Information
| Provider Information | |||||||||
| NPI: | 1316166564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHTABULA OB & GYNS INC | ||||||||
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| OtherOrganizationName: | UNIVERSITY PRIMARY CARE PRACTICES INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74987 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441940002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409982811 | ||||||||
| FaxNumber: | 4409975695 | ||||||||
| Practice Location | |||||||||
| Address1: | 2709 LAKE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHTABULA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440044959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409982811 | ||||||||
| FaxNumber: | 4409975695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 06/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | RIDDLE | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BILLING SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2163836480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.