Provider Demographics
NPI:1356546170
Name:WEST ASHLEY OBGYN PA
Entity type:Organization
Organization Name:WEST ASHLEY OBGYN PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:OYIBOKJA
Authorized Official - Last Name:MUGHELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-769-4424
Mailing Address - Street 1:1843 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4740
Mailing Address - Country:US
Mailing Address - Phone:843-769-4424
Mailing Address - Fax:843-769-4425
Practice Address - Street 1:1843 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4740
Practice Address - Country:US
Practice Address - Phone:843-769-4424
Practice Address - Fax:843-769-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146835Medicaid
SCGP0338Medicaid
SCGP0338Medicaid
SC146835Medicaid