Provider Demographics
NPI:1285457184
Name:FRUITFUL OAKS BIRTHING CENTER LLC
Entity type:Organization
Organization Name:FRUITFUL OAKS BIRTHING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE/ADVANCED PR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSEKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM/APRN
Authorized Official - Phone:580-609-0105
Mailing Address - Street 1:4086 N. COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533
Mailing Address - Country:US
Mailing Address - Phone:580-609-0105
Mailing Address - Fax:214-617-0352
Practice Address - Street 1:4086 N. COUNTRY CLUB RD
Practice Address - Street 2:SUITE 3
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:580-609-0105
Practice Address - Fax:214-617-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing