MEDICARE: MIAMI COUNTY OB-GYN ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1194376269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI COUNTY OB-GYN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1930 PRIME CT STE 105
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-9045
Country	:	US
Telephone Number	:	937-339-7982
Fax Number	:	937-339-7842

Provider Business Practice Location Address
First Line	:	1930 PRIME CT STE 105
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-9045
Country	:	US
Telephone Number	:	937-339-7982
Fax Number	:	937-339-7842

Authorized Official
Title or Position	:	MANAGER
Name	:	SUSAN J COVELLI
Credential	:
Telephone Number	:	937-339-7982

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/20/2019

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