Provider Demographics
NPI:1245404789
Name:OBSTETRICS AND GYNECOLOGY SOUTH, INC
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-296-0167
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:4600
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-296-0167
Mailing Address - Fax:
Practice Address - Street 1:758 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-3020
Practice Address - Country:US
Practice Address - Phone:937-746-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2008679Medicaid
OH2008679Medicaid
OHOB9286061Medicare PIN