Provider Demographics
NPI:1912097858
Name:JEFFREY A. BAUMGARDNER, M.D. & ASSOCIATES OB/GYN LLC
Entity type:Organization
Organization Name:JEFFREY A. BAUMGARDNER, M.D. & ASSOCIATES OB/GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-342-3565
Mailing Address - Street 1:940 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2520
Mailing Address - Country:US
Mailing Address - Phone:309-342-3565
Mailing Address - Fax:309-342-3511
Practice Address - Street 1:940 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2520
Practice Address - Country:US
Practice Address - Phone:309-342-3565
Practice Address - Fax:309-342-3511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI62267Medicare UPIN
ILK31172Medicare ID - Type Unspecified