Provider Demographics
NPI:1205827052
Name:OB GYN ASSOCIATES OF GREENE COUNTY,LLC
Entity Type:Organization
Organization Name:OB GYN ASSOCIATES OF GREENE COUNTY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-376-9731
Mailing Address - Street 1:121 S PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-2673
Mailing Address - Country:US
Mailing Address - Phone:937-376-9731
Mailing Address - Fax:937-376-5521
Practice Address - Street 1:121 S PROGRESS DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2673
Practice Address - Country:US
Practice Address - Phone:937-376-9731
Practice Address - Fax:937-376-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.075281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0702833OtherUHC
OH2256259Medicaid
359642086003OtherMEDICAL MUTUAL
7159289OtherAETNA
000000212130OtherANTHEM
D75281OtherHUMANA
0702833OtherUHC
7159289OtherAETNA