| Organization Name: | PROVIDENCE MEDICAL GROUP |
| NPI Number: | 1972533149 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN J BECKER (CHIEF OPERATING OFFICER) |
| Mailing Address: | 2912 Springboro Rd W Suite 201 Dayton |
| State: | OH US |
| Postal Code: | 454391674 |
| Phone Number: | 9372978999 |
| Fax Number: | 9372974852 |
| NPI Enumeration Date: | 07/04/2006 |
| NPI Last Update Date: | 10/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |