Healthcare Provider Details

I. General information

NPI: 1710621776
Provider Name (Legal Business Name): SEVEN HILLS OB-GYN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10307 DUPONT CIRCLE DR W STE A
FORT WAYNE IN
46825-1633
US

IV. Provider business mailing address

11595 N MERIDIAN ST STE 375
CARMEL IN
46032-3950
US

V. Phone/Fax

Practice location:
  • Phone: 260-458-3440
  • Fax: 260-458-3441
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN J FERNANDEZ
Title or Position: VP RCM
Credential:
Phone: 516-972-1568