Provider Demographics
NPI:1609835040
Name:OBSTETRICS-GYNECLOGY, INC.
Entity Type:Organization
Organization Name:OBSTETRICS-GYNECLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-664-5134
Mailing Address - Street 1:1389 N BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1913
Mailing Address - Country:US
Mailing Address - Phone:765-664-5134
Mailing Address - Fax:765-664-0469
Practice Address - Street 1:1389 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1913
Practice Address - Country:US
Practice Address - Phone:765-664-5134
Practice Address - Fax:765-664-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50000120A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN293070Medicare ID - Type Unspecified