MEDICARE: OCOEE OB/GYN, PC

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

General Provider Information

NPI Number	:	1801989678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCOEE OB/GYN, PC

Provider Business Mailing Address
First Line	:	2550 BUSINESS PARK DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-6503
Country	:	US
Telephone Number	:	423-339-8881
Fax Number	:	423-464-6126

Provider Business Practice Location Address
First Line	:	2550 BUSINESS PARK DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-6503
Country	:	US
Telephone Number	:	423-339-8881
Fax Number	:	423-464-6126

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRENDA ANNE SNOWMAN
Credential	:	MD
Telephone Number	:	423-339-8881

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	05/16/2016

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