Provider Demographics
NPI:1972658300
Name:SCOTTSBORO OB GYN SPECIALISTS LLC
Entity Type:Organization
Organization Name:SCOTTSBORO OB GYN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-259-5211
Mailing Address - Street 1:408 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2424
Mailing Address - Country:US
Mailing Address - Phone:256-259-5211
Mailing Address - Fax:256-259-6641
Practice Address - Street 1:408 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2424
Practice Address - Country:US
Practice Address - Phone:256-259-5211
Practice Address - Fax:256-259-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529908600Medicaid
AL529908600Medicaid