1235529223 NPI number — MIDVALLEY BIRTHING SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235529223 NPI number — MIDVALLEY BIRTHING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDVALLEY BIRTHING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235529223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2532 SANTIAM HWY SE
Provider Second Line Business Mailing Address:
#314
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97322-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-928-1002
Provider Business Mailing Address Fax Number:
541-981-2072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3111 SANTIAM HWY SE
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97322-5293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-928-1002
Provider Business Practice Location Address Fax Number:
541-981-2072
Provider Enumeration Date:
01/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
MAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-928-1002

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  DEM-LD-10156108 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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