Provider Demographics
NPI:1770511511
Name:SOUTHERN OHIO HEALTH SERVICES NETWORK
Entity Type:Organization
Organization Name:SOUTHERN OHIO HEALTH SERVICES NETWORK
Other - Org Name:SOUTHERN OHIO WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-7700
Mailing Address - Street 1:5162 ST. RT. 125
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121
Mailing Address - Country:US
Mailing Address - Phone:937-378-3633
Mailing Address - Fax:937-378-6153
Practice Address - Street 1:5162 ST. RT. 125
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121
Practice Address - Country:US
Practice Address - Phone:937-378-3633
Practice Address - Fax:937-378-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0824255Medicaid
OH0824255Medicaid