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General NPI Number Information
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NPI Number | 1306816079
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Entity Type | Organization
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Legal Business Name | OB-GYN ASSOCIATES, PA
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 3520 E. LOUISE DR
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-955-0350
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Fax | 208-955-0352
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Provider Business Mailing Address
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Address Line | 3520 E. LOUISE DR
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-955-0350
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Fax | 208-955-0352
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | KRISTI JO LYNN
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Credential |
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Telephone | 208-955-0340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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