Provider Demographics
NPI:1396097549
Name:OBSTETRICS & GYNECOLOGY SOUTH, INC
Entity type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY SOUTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-296-0167
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE 4600
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-296-0167
Mailing Address - Fax:937-297-2330
Practice Address - Street 1:2510 COMMONS BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3829
Practice Address - Country:US
Practice Address - Phone:937-558-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OBSTETRICS & GYNECOLOGY SOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-12
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.043084173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864888Medicaid
OH0723417Medicaid
OH2109935Medicaid
OH2792198Medicaid
OH0589144Medicaid
OH2008679Medicaid