Provider Demographics
NPI:1295765634
Name:GYNECOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:GYNECOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-339-6456
Mailing Address - Street 1:PO BOX 7075
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-7075
Mailing Address - Country:US
Mailing Address - Phone:812-339-6456
Mailing Address - Fax:812-339-6219
Practice Address - Street 1:654 S WALKER ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2159
Practice Address - Country:US
Practice Address - Phone:812-339-6456
Practice Address - Fax:812-339-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200002910AMedicaid
IN200002910AMedicaid