Provider Demographics
NPI:1750536124
Name:SEVEN SISTERS OBSTETRICS AND GYNECOLOGY, INC
Entity type:Organization
Organization Name:SEVEN SISTERS OBSTETRICS AND GYNECOLOGY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-543-1463
Mailing Address - Street 1:1035 PEACH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2700
Mailing Address - Country:US
Mailing Address - Phone:805-543-1475
Mailing Address - Fax:805-543-1463
Practice Address - Street 1:1035 PEACH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-543-1475
Practice Address - Fax:805-543-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87867207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87867Medicare PIN