Healthcare Provider Details

I. General information

NPI: 1881835106
Provider Name (Legal Business Name): JASPER OBSTETRICS AND GYNECOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 DORBETT ST
JASPER IN
47546-2615
US

IV. Provider business mailing address

613 DORBETT ST
JASPER IN
47546-2615
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-1289
  • Fax: 812-482-3993
Mailing address:
  • Phone: 812-482-1289
  • Fax: 812-482-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA COLVIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 812-481-2709