Provider Demographics
NPI:1750507067
Name:EDDY OB/GYN PLC
Entity Type:Organization
Organization Name:EDDY OB/GYN PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-899-3000
Mailing Address - Street 1:215 S DOBSON RD
Mailing Address - Street 2:#1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6227
Mailing Address - Country:US
Mailing Address - Phone:480-899-3000
Mailing Address - Fax:480-899-0527
Practice Address - Street 1:215 S DOBSON RD
Practice Address - Street 2:STE #1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-899-3000
Practice Address - Fax:480-899-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296956Medicaid
AZ24487Medicare ID - Type Unspecified
AZ296956Medicaid