Provider Demographics
NPI:1982618278
Name:OB/GYN SPECIALISTS OF SOUTHEASTERN OHIO, INC.
Entity Type:Organization
Organization Name:OB/GYN SPECIALISTS OF SOUTHEASTERN OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-439-8859
Mailing Address - Street 1:1230B CLARK STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9611
Mailing Address - Country:US
Mailing Address - Phone:740-439-8859
Mailing Address - Fax:740-439-8993
Practice Address - Street 1:1230B CLARK STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9611
Practice Address - Country:US
Practice Address - Phone:740-439-8859
Practice Address - Fax:740-439-8993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067443A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty