Provider Demographics
NPI:1972805372
Name:OVG INC
Entity type:Organization
Organization Name:OVG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:WSC
Authorized Official - Phone:904-540-4629
Mailing Address - Street 1:2116 WOOD STORK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8251
Mailing Address - Country:US
Mailing Address - Phone:904-540-4629
Mailing Address - Fax:904-824-9341
Practice Address - Street 1:2116 WOOD STORK AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8251
Practice Address - Country:US
Practice Address - Phone:904-540-4629
Practice Address - Fax:904-824-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690241398Medicaid
FL690241396Medicaid