Provider Demographics
NPI:1639345465
Name:NORTHWEST OBSTETRICS & GYNECOLOGY ASSOC INC
Entity Type:Organization
Organization Name:NORTHWEST OBSTETRICS & GYNECOLOGY ASSOC INC
Other - Org Name:MOBILE DEXA SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FACMPE
Authorized Official - Phone:614-777-4801
Mailing Address - Street 1:3841 TRUEMAN CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2496
Mailing Address - Country:US
Mailing Address - Phone:614-777-4801
Mailing Address - Fax:614-777-8644
Practice Address - Street 1:3841 TRUEMAN CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2496
Practice Address - Country:US
Practice Address - Phone:614-777-4801
Practice Address - Fax:614-777-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile