Provider Demographics
NPI:1831354471
Name:NORTHEAST OBSTETRICS & GYNECOLOGY, LLC
Entity type:Organization
Organization Name:NORTHEAST OBSTETRICS & GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:FURNISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-426-7755
Mailing Address - Street 1:2414 E STATE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4760
Mailing Address - Country:US
Mailing Address - Phone:260-422-7455
Mailing Address - Fax:260-422-0086
Practice Address - Street 1:2414 E STATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4760
Practice Address - Country:US
Practice Address - Phone:260-422-7455
Practice Address - Fax:260-422-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty