Provider Demographics
NPI:1467580415
Name:RIVERCHASE OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:RIVERCHASE OBSTETRICS & GYNECOLOGY
Other - Org Name:THE WOMENS CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLAUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-988-8294
Mailing Address - Street 1:130 RIVERCHASE PKWY E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1811
Mailing Address - Country:US
Mailing Address - Phone:205-988-8294
Mailing Address - Fax:205-403-0376
Practice Address - Street 1:130 RIVERCHASE PKWY E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1811
Practice Address - Country:US
Practice Address - Phone:205-988-8294
Practice Address - Fax:205-403-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084513Medicaid
AL000000042Medicaid
AL000011896Medicare ID - Type Unspecified
AL000000495Medicare ID - Type Unspecified
AL000000042Medicaid