MEDICARE: ADVANCED PELVIC SURGERY, LLC

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	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1922273291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PELVIC SURGERY, LLC

Provider Business Mailing Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9337
Country	:	US
Telephone Number	:	513-942-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9337
Country	:	US
Telephone Number	:	513-942-7640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT GREGORY OWENS
Credential	:	MD
Telephone Number	:	513-942-7640

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	05/28/2008

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