Provider Demographics
NPI:1154468809
Name:NORTHWEST OHIO OBGYN LLC
Entity Type:Organization
Organization Name:NORTHWEST OHIO OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DESRENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-369-4600
Mailing Address - Street 1:547 HARMON ROAD
Mailing Address - Street 2:P.O. BOX 129
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817
Mailing Address - Country:US
Mailing Address - Phone:419-369-4600
Mailing Address - Fax:419-369-4603
Practice Address - Street 1:547 HARMON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1033
Practice Address - Country:US
Practice Address - Phone:419-369-4600
Practice Address - Fax:419-369-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149624Medicaid
OHBR0895734Medicare PIN
OHH10275Medicare UPIN
OH2149624Medicaid