=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154468809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHWEST OHIO OBGYN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 01/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 547 HARMON RD
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45817-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-369-4600
-----------------------------------------------------
Fax | 419-369-4603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 HARMON ROAD P.O. BOX 129
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-369-4600
-----------------------------------------------------
Fax | 419-369-4603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESEDENT OWNER
-----------------------------------------------------
Name | DR. DESRENE K BROWN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 419-369-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------