Provider Demographics
NPI:1992913669
Name:MARION OBSTETRICS & GYNECOLOGY, LTD
Entity type:Organization
Organization Name:MARION OBSTETRICS & GYNECOLOGY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-998-9888
Mailing Address - Street 1:3331 W DEYOUNG ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5896
Mailing Address - Country:US
Mailing Address - Phone:618-998-9888
Mailing Address - Fax:618-993-5951
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-998-9888
Practice Address - Fax:618-993-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
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
IL209903Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILG29333Medicare UPIN