Provider Demographics
NPI:1366621419
Name:ADVANCED OB GYN SPECIALISTS INC
Entity type:Organization
Organization Name:ADVANCED OB GYN SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-9098
Mailing Address - Street 1:830 WEST HIGH
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-3969
Mailing Address - Country:US
Mailing Address - Phone:419-338-9098
Mailing Address - Fax:419-222-6604
Practice Address - Street 1:830 WEST HIGH
Practice Address - Street 2:SUITE 304
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3969
Practice Address - Country:US
Practice Address - Phone:419-338-9098
Practice Address - Fax:419-222-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037492207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9926101Medicare PIN