1881307585 NPI number — SERENITY MIDWIFERY & BIRTH CENTER

Table of content: DR. PAUL DERMOT JACKMAN D.C. (NPI 1801057369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881307585 NPI number — SERENITY MIDWIFERY & BIRTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERENITY MIDWIFERY & BIRTH CENTER
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:
1881307585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 HOLDER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXAHACHIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76041-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-872-7689
Provider Business Mailing Address Fax Number:
469-694-8464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
741 HOLDER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAXAHACHIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76041-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-872-7689
Provider Business Practice Location Address Fax Number:
469-694-8464
Provider Enumeration Date:
12/28/2022

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
ANDRAIA
Authorized Official Title or Position:
OWNER, CERTIFIED NURSE-MIDWIFE
Authorized Official Telephone Number:
972-827-7689

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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