Provider Demographics
NPI:1902867930
Name:OBSTETRICS AND GYNECOLOGY SOUTH INC
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-296-0167
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1273
Mailing Address - Country:US
Mailing Address - Phone:937-296-0167
Mailing Address - Fax:937-297-2330
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 4600
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1273
Practice Address - Country:US
Practice Address - Phone:937-296-0167
Practice Address - Fax:937-297-2330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBSTETRICS AND GYNECOLOGY SOUTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-29
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000322545OtherANTHEM
000000322545OtherANTHEM