PROVIDENCE MEDICAL GROUP INC NPI 1821373945

NPI Information

PROVIDENCE MEDICAL GROUP INC is an obstetrics gynecology in Centerville, OH. 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. PROVIDENCE MEDICAL GROUP INC NPI is 1821373945. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Providence Surgery Center@ Cornerstone.

The provider's business location address is:

7756 WASHINGTON VILLAGE DR
SUITE 125
CENTERVILLE, OH
ZIP 45459-999
Phone: (937) 297-8999

The provider's authorized official is Susan J Becker .
The authorized official title is Chief Operations Officer and has the following contact phone number (937) 297-8999.

The CLIA number assigned to this NPI record is 36D1054105 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/20/2011 and was last updated on 10/20/2011.

Taxonomy Codes

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Other Identifiers

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