Provider Demographics
NPI:1033104310
Name:MT AUBURN OBSTETRICS & GYNECOLOGIC ASSOC INC
Entity Type:Organization
Organization Name:MT AUBURN OBSTETRICS & GYNECOLOGIC ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCHOELLES
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-241-4774
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:SUITE 724
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-4774
Mailing Address - Fax:513-241-1682
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SUITE 724
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-4774
Practice Address - Fax:513-241-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303120Medicaid
MT9264481Medicare ID - Type Unspecified
OHMT9264482Medicare PIN
OH0303120Medicaid
OH0560150005Medicare NSC