Provider Demographics
NPI:1245401603
Name:OB-GYN ASSOC OF ABERDEEN
Entity type:Organization
Organization Name:OB-GYN ASSOC OF ABERDEEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-225-1636
Mailing Address - Street 1:310 SOUTH PENN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4553
Mailing Address - Country:US
Mailing Address - Phone:605-225-1636
Mailing Address - Fax:605-229-2434
Practice Address - Street 1:310 SOUTH PENN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4553
Practice Address - Country:US
Practice Address - Phone:605-225-1636
Practice Address - Fax:605-229-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3462Medicare PIN