MEDICARE: SOUTHPOINTE OBGYN, 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	207V00000X	Obstetrics & Gynecology Physician		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306160254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHPOINTE OBGYN, LLC

Provider Business Mailing Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 205
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-710-2324
Fax Number	:	540-710-2381

Provider Business Practice Location Address
First Line	:	4710 SPOTSYLVANIA PKWY
Second Line	:	SUITE 205
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-9433
Country	:	US
Telephone Number	:	540-371-4488
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	ASHLEIGH A RAUBENOLT
Credential	:
Telephone Number	:	540-371-4488

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	08/06/2010

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