Organization · NPI-2
Obhg Illinois Sc
Obstetrics & Gynecology · Berwyn, IL
NPI number1700107216
StatusActive
Last updated in NPPESJan 10, 2019
Details
- NPI
- 1700107216
- Entity type
- Organization (NPI-2)
- Legal business name
- Obhg Illinois Sc
- Organization subpart
- No
- Enumeration date
- Jun 18, 2010
- Last updated
- Jan 10, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207V00000X | Obstetrics & Gynecology | – | – | Yes |
| 207P00000X | Emergency Medicine | – | – | |
| 208M00000X | Hospitalist | – | – |
Practice location
3249 Oak Park AveBerwyn, IL 60402-3429
Phone 800-967-2289 · Fax 864-627-9920
Mailing address
777 Lowndes Hill Rd Bldg 1Greenville, SC 29607-2131
Phone 800-967-2289 · Fax 864-627-9920
Authorized official
Lester C Jurgens
Ceo
8009672289
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