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General NPI Number Information
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NPI Number | 1578818159
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Entity Type | Organization
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Legal Business Name | OB GYN CARE OF NORTHEAST MISSOURI LLC
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 18385 DAIRY WAY
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City | KIRKSVILLE
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State | MO
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Zip | 63501-7519
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Country | US
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Telephone | 281-235-6789
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Fax |
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Provider Business Mailing Address
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Address Line | 800 W JEFFERSON ST SECOND FLOOR
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City | KIRKSVILLE
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State | MO
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Zip | 63501-1443
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Country | US
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Telephone | 281-235-6789
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANASTASIA SOLOVIEVA
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Credential | MD
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Telephone | 281-827-7715
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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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