Provider Demographics
NPI:1467583203
Name:ATHENS MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ATHENS MEDICAL ASSOCIATES, LLC
Other - Org Name:RIVER ROSE OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-594-7979
Mailing Address - Street 1:510 W UNION ST
Mailing Address - Street 2:STE A
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2331
Mailing Address - Country:US
Mailing Address - Phone:740-594-7979
Mailing Address - Fax:
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:STE 260
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-594-8819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09347363LX0001X
OHNM09326367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty