Provider Demographics
NPI:1003807470
Name:WOOSTER OBSTETRICS & GYNECOLOGY INC
Entity Type:Organization
Organization Name:WOOSTER OBSTETRICS & GYNECOLOGY INC
Other - Org Name:WOOSTER OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-345-2229
Mailing Address - Street 1:546 WINTER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2300
Mailing Address - Country:US
Mailing Address - Phone:330-345-2229
Mailing Address - Fax:330-345-2236
Practice Address - Street 1:546 WINTER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2300
Practice Address - Country:US
Practice Address - Phone:330-345-2229
Practice Address - Fax:330-345-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2025641Medicaid
OH=========004OtherHEALTH ASSURANCE
OH=========1A00OtherANTHEM BC/BS
OH2025641Medicaid
OH=========027OtherCARESOURCE
OHWO9292731Medicare PIN
OH2025641Medicaid