Provider Demographics
NPI:1578818159
Name:OB GYN CARE OF NORTHEAST MISSOURI LLC
Entity Type:Organization
Organization Name:OB GYN CARE OF NORTHEAST MISSOURI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOVIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-827-7715
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1443
Mailing Address - Country:US
Mailing Address - Phone:281-235-6789
Mailing Address - Fax:
Practice Address - Street 1:18385 DAIRY WAY
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-7519
Practice Address - Country:US
Practice Address - Phone:281-235-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty