Healthcare Provider Details

I. General information

NPI: 1346267788
Provider Name (Legal Business Name): BELLEFONTAINE OB GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 RUSH AVE
BELLEFONTAINE OH
43311
US

IV. Provider business mailing address

1125 RUSH AVE PO BOX 879
BELLEFONTAINE OH
43311
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-3538
  • Fax: 937-599-4712
Mailing address:
  • Phone: 937-599-3538
  • Fax: 937-599-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN220340NM07070
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35041219M
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34004809Z
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34002858B
License Number StateOH

VIII. Authorized Official

Name: JAY E MEYER
Title or Position: PRESIDENT
Credential: MD
Phone: 937-599-3538