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NPI Code Detail

MEDICARE: SOUTHSIDE OB-GYN PC

MEDICARE: SOUTHSIDE OB-GYN PC
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
1207V00000XObstetrics & Gynecology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1518186881
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE OB-GYN PC
Provider Business Mailing Address
First Line : 8051 S EMERSON AVE STE 400
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-8633
Country : US
Telephone Number : 317-865-3600
Fax Number : 317-885-3850
Provider Business Practice Location Address
First Line : 8051 S EMERSON AVE STE 400
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-8633
Country : US
Telephone Number : 317-865-3600
Fax Number : 317-885-3850
Authorized Official
Title or Position : CEO
Name : MS. JOCELYN FOREHAND
Credential : MJ,CMPE, CPC
Telephone Number : 317-865-3600
Provider Enumeration Date : 04/25/2007
Last Update Date : 12/19/2018

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Directions to “SOUTHSIDE OB-GYN PC ” Practice Location

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