Provider Demographics
NPI:1760586259
Name:LADIES FIRST OB/GYN OBSTETRICAL SERVICES, PC
Entity Type:Organization
Organization Name:LADIES FIRST OB/GYN OBSTETRICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-9107
Mailing Address - Street 1:1103 WEBER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3345
Mailing Address - Country:US
Mailing Address - Phone:573-756-9107
Mailing Address - Fax:573-756-9630
Practice Address - Street 1:1103 WEBER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3345
Practice Address - Country:US
Practice Address - Phone:573-756-9107
Practice Address - Fax:573-756-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505786905Medicaid
MO000013441Medicare ID - Type Unspecified