1841648276 NPI number — EMERALD OBSTETRICS AND GYNECOLOGY LLC

Table of content: (NPI 1841648276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841648276 NPI number — EMERALD OBSTETRICS AND GYNECOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD OBSTETRICS AND GYNECOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841648276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 DUBLIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43215-7048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-255-5349
Provider Business Mailing Address Fax Number:
614-467-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4461 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
GROVE CITY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43123-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-875-0444
Provider Business Practice Location Address Fax Number:
614-875-1193
Provider Enumeration Date:
05/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HAGERTY
Authorized Official First Name:
GENEVIEVE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER PHYSICIAN
Authorized Official Telephone Number:
614-875-0444

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35077048 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2342414 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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