Provider Demographics
NPI:1023176393
Name:OB-GYN SPECIALISTS OF NORTHERN KY
Entity type:Organization
Organization Name:OB-GYN SPECIALISTS OF NORTHERN KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEVINGTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CMPE
Authorized Official - Phone:859-341-2510
Mailing Address - Street 1:20 MEDICAL VILLAGE DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-341-2510
Mailing Address - Fax:859-578-2004
Practice Address - Street 1:20 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-341-2510
Practice Address - Fax:859-578-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0229Medicare PIN