Provider Demographics
NPI:1407050644
Name:OB-GYN HEALTH CENTER P A
Entity Type:Organization
Organization Name:OB-GYN HEALTH CENTER P A
Other - Org Name:OB-GYN HEALTH CENTER P A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-258-0123
Mailing Address - Street 1:1445 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1437
Mailing Address - Country:US
Mailing Address - Phone:386-258-0123
Mailing Address - Fax:
Practice Address - Street 1:1445 DUNN AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1437
Practice Address - Country:US
Practice Address - Phone:386-258-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0275Medicare PIN