Provider Demographics
NPI:1194376269
Name:MIAMI COUNTY OB-GYN ASSOCIATES LLC
Entity Type:Organization
Organization Name:MIAMI COUNTY OB-GYN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-339-7982
Mailing Address - Street 1:1930 PRIME CT STE 105
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9045
Mailing Address - Country:US
Mailing Address - Phone:937-339-7982
Mailing Address - Fax:937-339-7842
Practice Address - Street 1:1930 PRIME CT STE 105
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9045
Practice Address - Country:US
Practice Address - Phone:937-339-7982
Practice Address - Fax:937-339-7842
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI COUNTY OB-GYN ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical