Provider Demographics
NPI:1538402003
Name:APP MATERNAL FETAL MEDICINE
Entity type:Organization
Organization Name:APP MATERNAL FETAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP EXECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:BODAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-789-4129
Mailing Address - Street 1:PO BOX 748157
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8157
Mailing Address - Country:US
Mailing Address - Phone:541-789-5250
Mailing Address - Fax:541-789-5538
Practice Address - Street 1:2911 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8179
Practice Address - Country:US
Practice Address - Phone:541-789-5982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASANTE PHYSICIAN PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty