Provider Demographics
NPI:1730218728
Name:OBGYN INC
Entity type:Organization
Organization Name:OBGYN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:FLANNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-532-2322
Mailing Address - Street 1:911 LIGONIER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-532-2322
Mailing Address - Fax:724-532-2405
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-532-2322
Practice Address - Fax:724-532-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008358050002Medicaid
PA0008358050002Medicaid
PAE92239Medicare UPIN