Provider Demographics
NPI:1306816079
Name:OB-GYN ASSOCIATES, PA
Entity Type:Organization
Organization Name:OB-GYN ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI JO
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-955-0340
Mailing Address - Street 1:3520 E. LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-955-0350
Mailing Address - Fax:208-955-0352
Practice Address - Street 1:3520 E. LOUISE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-955-0350
Practice Address - Fax:208-955-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226971Medicaid
OR226972Medicaid
ID89284OtherBLUE CROSS; CALDWELL
ID002415100Medicaid
ID8C246OtherBLUE CROSS; MERIDIAN
ID89284OtherBLUE CROSS; CALDWELL