Provider Demographics
NPI:1417939521
Name:OBSTETRICS & GYNECOLOGY ASSOC.
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:407-846-7200
Mailing Address - Street 1:2400 N. ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4198
Mailing Address - Country:US
Mailing Address - Phone:407-846-7200
Mailing Address - Fax:407-846-3989
Practice Address - Street 1:2400 N. ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 300
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-846-7200
Practice Address - Fax:407-846-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74163207V00000X
FLME 46628207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty