Provider Demographics
NPI:1750352894
Name:OBSTETRICS GYNECOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:OBSTETRICS GYNECOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-842-7080
Mailing Address - Street 1:1793 CLIFF GOOKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6723
Mailing Address - Country:US
Mailing Address - Phone:662-842-1161
Mailing Address - Fax:662-844-4107
Practice Address - Street 1:1793 CLIFF GOOKIN BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6723
Practice Address - Country:US
Practice Address - Phone:662-842-1161
Practice Address - Fax:662-844-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCM7073OtherRAILROAD MEDICARE GROUP
MS09014159Medicaid
MSCM7073OtherRAILROAD MEDICARE GROUP