Providence Medical Group INC

NPI #1821373945 in Centerville, Ohio

Provider Information

NPI Number: 1821373945
Entity Type: Organization
Organization Name: Providence Medical Group INC
Subpart: Yes (part of a larger organization)
Parent Organization: PROVIDENCE MEDICAL GROUP
Primary Specialty: Obstetrics & Gynecology
Enumeration Date: Oct 20, 2011
Last Updated: Oct 20, 2011

Practice Location

Address: 7756 WASHINGTON VILLAGE DR
Address 2: SUITE 125
City: Centerville
State: Ohio
ZIP Code: 45459-3999
Phone: (937) 297-8999

Authorized Official

Name: MRS. SUSAN J BECKER, COO
Title: CHIEF OPERATIONS OFFICER
Phone: (937) 297-8999

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Obstetrics & Gynecology	207V00000X	Primary

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