Provider Demographics
NPI:1760812499
Name:PACIFIC OB-GYN, MIDWIFERY & NURSING CORP
Entity Type:Organization
Organization Name:PACIFIC OB-GYN, MIDWIFERY & NURSING CORP
Other - Org Name:PACIFIC OB-GYN AND MIDWIFERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:O BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP, RN, NPF, MIDWIFE
Authorized Official - Phone:707-498-8022
Mailing Address - Street 1:3200 WALFORD AVE # B
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4828
Mailing Address - Country:US
Mailing Address - Phone:707-498-8022
Mailing Address - Fax:
Practice Address - Street 1:3200 WALFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4828
Practice Address - Country:US
Practice Address - Phone:707-445-3443
Practice Address - Fax:707-445-1848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty