MEDICARE: SOUTHWEST OHIO OB/GYN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	400375	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174521645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST OHIO OB/GYN INC

Provider Business Mailing Address
First Line	:	20 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-5155
Country	:	US
Telephone Number	:	513-424-1654
Fax Number	:	513-424-8205

Provider Business Practice Location Address
First Line	:	20 S BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-5155
Country	:	US
Telephone Number	:	513-424-1654
Fax Number	:	513-424-8205

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOYCE E RUSTERHOLZ
Credential	:	MD
Telephone Number	:	513-424-1654

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	03/03/2008

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Directions to “SOUTHWEST OHIO OB/GYN INC ” Practice Location

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