SOUTHBRIDGE OB GYN ASSOC NPI 1245393305

NPI Information

  • NPI: 1245393305
  • Provider Name: SOUTHBRIDGE OB GYN ASSOC
  • Classification: Obstetrics & Gynecology - 207V00000X
  • Entity Type: Organization
  • CLIA Number: 22D2201412
  • Address: 100 SOUTH ST
    STE G05
    SOUTHBRIDGE, MA
    ZIP 01550
  • Phone: (508) 765-5981

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NPI Details

SOUTHBRIDGE OB GYN ASSOC is an obstetrics gynecology in Southbridge, MA. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. SOUTHBRIDGE OB GYN ASSOC NPI is 1245393305. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

100 SOUTH ST
STE G05
SOUTHBRIDGE, MA
ZIP 01550
Phone: (508) 765-5981

The provider's authorized official is Melissa Ann Johnson .
The authorized official title is Physician and has the following contact phone number (508) 765-5981.

The CLIA number assigned to this NPI record is 22D2201412 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/19/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & GynecologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19763236MEDICAIDMASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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