Provider Demographics
NPI:1972789394
Name:MIAMI COUNTY OB-GYN ASSOCIATES LLC
Entity type:Organization
Organization Name:MIAMI COUNTY OB-GYN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-339-7982
Mailing Address - Street 1:3130 N DIXIE HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-339-7982
Mailing Address - Fax:937-339-7842
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-339-7982
Practice Address - Fax:937-339-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-3592-D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314043Medicaid