Healthcare Provider Details

I. General information

NPI: 1710205919
Provider Name (Legal Business Name): ASHTABULA OB & GYNS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 LAKE AVE
ASHTABULA OH
44004-4959
US

IV. Provider business mailing address

PO BOX 8792
BELFAST ME
04915-8792
US

V. Phone/Fax

Practice location:
  • Phone: 440-998-2811
  • Fax: 440-997-5695
Mailing address:
  • Phone: 440-998-2811
  • Fax: 440-997-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVE RIDDLE
Title or Position: DIRECTOR OF BILLING SERVICES
Credential:
Phone: 216-383-6480