Healthcare Provider Details

I. General information

NPI: 1174521645
Provider Name (Legal Business Name): SOUTHWEST OHIO OB/GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S BREIEL BLVD
MIDDLETOWN OH
45044-5155
US

IV. Provider business mailing address

20 S BREIEL BLVD
MIDDLETOWN OH
45044-5155
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-1654
  • Fax: 513-424-8205
Mailing address:
  • Phone: 513-424-1654
  • Fax: 513-424-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number400375
License Number StateOH

VIII. Authorized Official

Name: DR. JOYCE E RUSTERHOLZ
Title or Position: PRESIDENT
Credential: MD
Phone: 513-424-1654