Provider Demographics
NPI:1780869073
Name:GROVE CITY OBSTETRICS & GYNECOLOGY INC.
Entity type:Organization
Organization Name:GROVE CITY OBSTETRICS & GYNECOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-255-5349
Mailing Address - Street 1:2399 OLD STRINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2919
Mailing Address - Country:US
Mailing Address - Phone:614-875-4191
Mailing Address - Fax:
Practice Address - Street 1:1241 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7048
Practice Address - Country:US
Practice Address - Phone:614-255-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGR9308601OtherGROUP MEDICARE NUMBER