Provider Demographics
NPI:1215948187
Name:OB GYN ASSOCIATES OF SOUTHERN IN
Entity type:Organization
Organization Name:OB GYN ASSOCIATES OF SOUTHERN IN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-945-5233
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-945-5233
Mailing Address - Fax:812-945-2804
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-945-5233
Practice Address - Fax:812-945-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50002020A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115830AMedicaid
IN242100Medicare PIN