Provider Demographics
NPI:1912236381
Name:OB HOSPITALIST GROUP
Entity Type:Organization
Organization Name:OB HOSPITALIST GROUP
Other - Org Name:OB HOSPITALIST GROUP SJE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-967-2289
Mailing Address - Street 1:PO BOX 6806
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-6806
Mailing Address - Country:US
Mailing Address - Phone:800-967-2289
Mailing Address - Fax:864-752-1227
Practice Address - Street 1:150 N EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-967-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OB HOSPITALIST GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100102130Medicaid
KY9093477OtherAETNA PROVIDER #
KY000000642397OtherANTHEM BCBS PROVIDER #
KY9093477OtherAETNA PROVIDER #