# HEATHROW OB GYN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184894149
- **Authorized official:** JOHN JOHANNESSEN (VP OPERATIONS)
- **Authorized official phone:** (386) 775-4448

## Contact information

- **Practice address:** 942 SAXON BLVD, SUITE A, ORANGE CITY, FL 32763-8358
- **Practice address phone:** (386) 775-4448
- **Practice address fax:** (386) 775-4449
- **Mailing address:** 942 SAXON BLVD, SUITE A, ORANGE CITY, FL 32763-8358
- **Mailing address phone:** (386) 775-4448
- **Mailing address fax:** (386) 775-4449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2008
- **Last updated:** 03/06/2008