Provider Demographics
NPI:1750010070
Name:SOUTHERN OBSTETRIC & GYNECO ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN OBSTETRIC & GYNECO ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RENSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-526-2209
Mailing Address - Street 1:9447 HOLY CROSS LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-2209
Mailing Address - Fax:618-526-7372
Practice Address - Street 1:7342 IL 162
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-3162
Practice Address - Country:US
Practice Address - Phone:800-393-7642
Practice Address - Fax:618-526-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty