Provider Demographics
NPI:1396856456
Name:OB GYN ASSOCIATES LLC
Entity Type:Organization
Organization Name:OB GYN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-884-9000
Mailing Address - Street 1:6900 PEARL RD.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3640
Mailing Address - Country:US
Mailing Address - Phone:440-884-9000
Mailing Address - Fax:440-884-4929
Practice Address - Street 1:6900 PEARL RD.
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130-3640
Practice Address - Country:US
Practice Address - Phone:440-884-9000
Practice Address - Fax:440-884-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID