# PROVIDENCE MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE MEDICAL GROUP
- **Other names:** Providence Surgery Center@ Cornerstone
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821373945
- **Legal business name:** PROVIDENCE MEDICAL GROUP
- **Authorized official:** MRS. SUSAN J BECKER COO (CHIEF OPERATIONS OFFICER)
- **Authorized official phone:** (937) 297-8999

## Contact information

- **Practice address:** 7756 WASHINGTON VILLAGE DR, SUITE 125, CENTERVILLE, OH 45459-3999
- **Practice address phone:** (937) 297-8999
- **Mailing address:** 2912 SPRINGBORO RD, SUITE 201, MORAINE, OH 45439-1674
- **Mailing address phone:** (937) 297-8999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 005030 | OH | Yes |

## Other

- **Enumeration date:** 10/20/2011
- **Last updated:** 10/20/2011