Provider Demographics
NPI:1639269822
Name:OBSTETRIC & GYNCOLOGIC ASSOCS OF OAK RIDGE
Entity Type:Organization
Organization Name:OBSTETRIC & GYNCOLOGIC ASSOCS OF OAK RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-483-7415
Mailing Address - Street 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-483-7415
Mailing Address - Fax:865-483-7980
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:SUITE 140
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830
Practice Address - Country:US
Practice Address - Phone:865-483-7415
Practice Address - Fax:865-483-7980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379961Medicaid
TNB03661Medicare UPIN
TN3379961Medicaid
TNE04268Medicare UPIN
TNB02965Medicare UPIN
TNB04215Medicare UPIN
TNG82185Medicare UPIN