Provider Demographics
NPI:1093265456
Name:TRIBE513, PA
Entity Type:Organization
Organization Name:TRIBE513, PA
Other - Org Name:VIDA GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR, PROVIDER RELATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:OOSTDYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-720-1299
Mailing Address - Street 1:274 COMMONWEALTH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4869
Mailing Address - Country:US
Mailing Address - Phone:864-720-1299
Mailing Address - Fax:864-720-1300
Practice Address - Street 1:274 COMMONWEALTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4869
Practice Address - Country:US
Practice Address - Phone:864-720-1299
Practice Address - Fax:864-720-1300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIBE513, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty