Provider Demographics
NPI:1811959042
Name:OTTUMWA OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:OTTUMWA OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-682-8761
Mailing Address - Street 1:1005 PENNSYLVANIA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2195
Mailing Address - Country:US
Mailing Address - Phone:641-682-8761
Mailing Address - Fax:641-682-2764
Practice Address - Street 1:1005 PENNSYLVANIA
Practice Address - Street 2:SUITE 204
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2195
Practice Address - Country:US
Practice Address - Phone:641-682-8761
Practice Address - Fax:641-682-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0096800Medicaid
IA0096800Medicaid