Providence Medical Group Inc

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

005030 Issued in OH

Legal business name

PROVIDENCE MEDICAL GROUP INC

Practice address

7756 Washington Village Dr
Suite 125
Centerville, OH 45459-3999

Phone

(937) 297-8999

NPI assigned

Oct 20, 2011

Organization subpart

Yes

Parent organization

PROVIDENCE MEDICAL GROUPAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Susan J Becker, COO

Title

Chief Operations Officer

Phone

(937) 297-8999

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence Surgery Center@ Cornerstone Doing business as

Tax ID family

Providence Medical Group Inc3 organizations share this tax ID, including this one

Part of

Providence Medical Group Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Medical Group

  • Clinical Medical Laboratory
  • Moraine, OH
  • NPI 1760658371
  NPD tax ID
• Providence Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Moraine, OH
  • NPI 1659726768
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319068800000",
    "number": "1821373945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2912 SPRINGBORO RD",
            "address_2": "SUITE 201",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454391674",
            "telephone_number": "937-297-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7756 WASHINGTON VILLAGE DR",
            "address_2": "SUITE 125",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454593999",
            "telephone_number": "937-297-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE MEDICAL GROUP",
        "enumeration_date": "2011-10-20",
        "last_updated": "2011-10-20",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "937-297-8999",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "COO"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "OH",
            "license": "005030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2380294",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Surgery Center@ Cornerstone",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Taylor Prine
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• David Propst, D.O.
• Cherish Joy Prutzman, M.D
• Prymekare, LLC
• Prymekare, LLC
• Psi Surgery Center, LLC.
• Psychotherapy & Addiction Srvcs., Inc.

• Obstetrics & Gynecology Physician in Centerville, OH
• Providers in Centerville, OH by specialty
• Obstetrics & Gynecology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.