Provider Demographics
NPI:1811328206
Name:PREMIER WOMENS HEALTH OB/GYN
Entity type:Organization
Organization Name:PREMIER WOMENS HEALTH OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-642-4400
Mailing Address - Street 1:610 BLACKWATER RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9003
Mailing Address - Country:US
Mailing Address - Phone:740-642-4400
Mailing Address - Fax:740-642-4407
Practice Address - Street 1:610 BLACKWATER RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9003
Practice Address - Country:US
Practice Address - Phone:740-642-4400
Practice Address - Fax:740-642-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0233205Medicaid
OH2055645Medicaid
OHY10814455Medicare PIN
OHG77157Medicare UPIN
OHG39991Medicare UPIN
OH0233205Medicaid