Healthcare Provider Details

I. General information

NPI: 1639345465
Provider Name (Legal Business Name): NORTHWEST OBSTETRICS & GYNECOLOGY ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 TRUEMAN CT
HILLIARD OH
43026-2496
US

IV. Provider business mailing address

3841 TRUEMAN CT
HILLIARD OH
43026-2496
US

V. Phone/Fax

Practice location:
  • Phone: 614-777-4801
  • Fax: 614-777-8644
Mailing address:
  • Phone: 614-777-4801
  • Fax: 614-777-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI L KNISLEY
Title or Position: PRACTICE ADMINISTRATOR
Credential: FACMPE
Phone: 614-777-4801