Provider Demographics
NPI:1215078977
Name:REGIONAL OBSTETRIC CONSULTANTS
Entity type:Organization
Organization Name:REGIONAL OBSTETRIC CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-398-7684
Mailing Address - Street 1:836 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8334
Mailing Address - Country:US
Mailing Address - Phone:904-398-7684
Mailing Address - Fax:904-398-4998
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 1800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-398-7684
Practice Address - Fax:904-398-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77611OtherBLUE CROSS BLUE SHHIELD