Provider Demographics
NPI:1497826804
Name:GYN LTD
Entity Type:Organization
Organization Name:GYN LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-962-9541
Mailing Address - Street 1:1050 REID PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1907
Mailing Address - Country:US
Mailing Address - Phone:765-962-9541
Mailing Address - Fax:765-966-5952
Practice Address - Street 1:1050 REID PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1907
Practice Address - Country:US
Practice Address - Phone:765-962-9541
Practice Address - Fax:765-966-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50000322207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
902530Medicare ID - Type Unspecified