Provider Demographics
NPI:1558776245
Name:INNOVATIVE FERTILITY OF OHIO, LLC
Entity Type:Organization
Organization Name:INNOVATIVE FERTILITY OF OHIO, LLC
Other - Org Name:SPRINGCREEK FERTILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROLL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-458-5084
Mailing Address - Street 1:3516 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1116
Mailing Address - Country:US
Mailing Address - Phone:937-293-4111
Mailing Address - Fax:
Practice Address - Street 1:8087 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45458-1840
Practice Address - Country:US
Practice Address - Phone:937-458-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-22
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084514207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty