Provider Demographics
NPI:1770692139
Name:ASSOCIATES IN CENTRAL OHIO OBSTERTICS & GYNECOLOGY, INC.
Entity type:Organization
Organization Name:ASSOCIATES IN CENTRAL OHIO OBSTERTICS & GYNECOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:614-856-3388
Mailing Address - Street 1:6482 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7312
Mailing Address - Country:US
Mailing Address - Phone:614-856-0327
Mailing Address - Fax:614-856-3300
Practice Address - Street 1:6482 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7312
Practice Address - Country:US
Practice Address - Phone:614-856-0327
Practice Address - Fax:614-856-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID
OH9283643Medicare PIN
OH9283642Medicare PIN
OH9283641Medicare PIN