Provider Demographics
NPI:1164449930
Name:ALTOONA OB/GYN ASSOCIATES, INC.
Entity type:Organization
Organization Name:ALTOONA OB/GYN ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-944-7097
Mailing Address - Street 1:1701 12TH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3100
Mailing Address - Country:US
Mailing Address - Phone:814-944-5062
Mailing Address - Fax:814-944-5557
Practice Address - Street 1:1701 12TH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3100
Practice Address - Country:US
Practice Address - Phone:814-944-5062
Practice Address - Fax:814-944-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068355L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008400670001Medicaid
PA1008400670001Medicaid