Provider Demographics
NPI:1235398397
Name:OBSTETRICS & GYNECOLOGY SPECIALISTS INC
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY SPECIALISTS INC
Other - Org Name:DAVID A KALLENBERGER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/CREDENTIALING MGR.
Authorized Official - Prefix:
Authorized Official - First Name:BETTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-521-1969
Mailing Address - Street 1:3433 NW 56TH ST STE 210B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4445
Mailing Address - Country:US
Mailing Address - Phone:405-945-4701
Mailing Address - Fax:405-945-4728
Practice Address - Street 1:3433 NW 56TH ST STE 210B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4445
Practice Address - Country:US
Practice Address - Phone:405-945-4701
Practice Address - Fax:405-945-4728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10881207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
441482472Medicare PIN
C95049Medicare UPIN