Healthcare Provider Details

I. General information

NPI: 1811652704
Provider Name (Legal Business Name): OB HOSPITALIST GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11190 HEALTH PARK BLVD
NAPLES FL
34110-5729
US

IV. Provider business mailing address

777 LOWNDES HILL RD BLDG 1
GREENVILLE SC
29607-2101
US

V. Phone/Fax

Practice location:
  • Phone: 864-908-3530
  • Fax:
Mailing address:
  • Phone: 864-906-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE BURNS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 864-908-3604