Provider Demographics
NPI:1346267788
Name:BELLEFONTAINE OB GYN INC
Entity Type:Organization
Organization Name:BELLEFONTAINE OB GYN INC
Other - Org Name:BELLEFONTAINE OB GYN INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-599-3538
Mailing Address - Street 1:1125 RUSH AVE
Mailing Address - Street 2:PO BOX 879
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311
Mailing Address - Country:US
Mailing Address - Phone:937-599-3538
Mailing Address - Fax:937-599-4712
Practice Address - Street 1:1125 RUSH AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-599-3538
Practice Address - Fax:937-599-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041219M207V00000X
OH34004809Z207V00000X
OH34002858B207V00000X
RN220340NM07070367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412664Medicaid
OHC02210Medicare ID - Type Unspecified