Provider Demographics
NPI:1578555330
Name:SOUTHWESTERN OBSTETRICS AND GYNECOLOGY, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN OBSTETRICS AND GYNECOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-875-0444
Mailing Address - Street 1:4461 S. BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3990
Mailing Address - Country:US
Mailing Address - Phone:614-875-0444
Mailing Address - Fax:614-875-1193
Practice Address - Street 1:4461 S. BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3990
Practice Address - Country:US
Practice Address - Phone:614-875-0444
Practice Address - Fax:614-875-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0700509OtherUNITED HEALTHCARE GROUP #
OH0734478Medicaid
OH9925921Medicare ID - Type UnspecifiedMEDICARE GROUP #