Healthcare Provider Details

I. General information

NPI: 1649349911
Provider Name (Legal Business Name): TRI COUNTY OB GYN ASSOCIATES PLC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 NEW MOODY LANE TRI COUNTY OB GYN ASSOCIATES INC SUITE 103
LA GRANGE KY
40031-9179
US

IV. Provider business mailing address

1023 NEW MOODY LN STE 103
LA GRANGE KY
40031-9179
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-5558
  • Fax: 502-222-3040
Mailing address:
  • Phone: 502-222-5558
  • Fax: 502-222-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY STEWART SPAULDING
Title or Position: PARTNER
Credential: M.D.
Phone: 502-222-5558