Basic Information
| Provider Information | |||||||||
| NPI: | 1831360940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASHLAND OB-GYN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 934 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448054063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192892464 | ||||||||
| FaxNumber: | 4192893675 | ||||||||
| Practice Location | |||||||||
| Address1: | 934 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448054063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192892464 | ||||||||
| FaxNumber: | 4192893675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2008 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | ALLMAN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4192892464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 60132 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0920767 | 05 | OH | MEDICAID |