Provider Demographics
NPI:1881835106
Name:JASPER OBSTETRICS AND GYNECOLOGY INC
Entity Type:Organization
Organization Name:JASPER OBSTETRICS AND GYNECOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEHRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-1289
Mailing Address - Street 1:613 DORBETT ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2615
Mailing Address - Country:US
Mailing Address - Phone:812-482-1289
Mailing Address - Fax:812-482-3993
Practice Address - Street 1:613 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2615
Practice Address - Country:US
Practice Address - Phone:812-482-1289
Practice Address - Fax:812-482-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200938170AMedicaid
IN261580Medicare PIN