Provider Demographics
NPI:1033137732
Name:OB-GYN SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:OB-GYN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DISTRETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-767-9368
Mailing Address - Street 1:6401 POPLAR AVE STE 530
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4840
Mailing Address - Country:US
Mailing Address - Phone:909-767-9368
Mailing Address - Fax:901-767-9496
Practice Address - Street 1:6401 POPLAR AVE STE 530
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4840
Practice Address - Country:US
Practice Address - Phone:909-767-9368
Practice Address - Fax:901-767-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3701647Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER