Provider Demographics
NPI:1265512289
Name:RIVER OAKS OB/GYN ASSOCIATES, P.C.
Entity type:Organization
Organization Name:RIVER OAKS OB/GYN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-295-8805
Mailing Address - Street 1:2405 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1417
Mailing Address - Country:US
Mailing Address - Phone:574-295-8805
Mailing Address - Fax:574-522-0039
Practice Address - Street 1:2405 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1417
Practice Address - Country:US
Practice Address - Phone:574-295-8805
Practice Address - Fax:574-522-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100112330AMedicaid
IN224650Medicare ID - Type UnspecifiedGROUP IDENTIFICATION #
IN1056320001Medicare NSC