Provider Demographics
NPI:1285750786
Name:BIRTHROOT MIDWIFERY SERVICE
Entity type:Organization
Organization Name:BIRTHROOT MIDWIFERY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:TIVE
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:360-734-2182
Mailing Address - Street 1:2429 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2729
Mailing Address - Country:US
Mailing Address - Phone:360-734-2182
Mailing Address - Fax:360-752-2498
Practice Address - Street 1:2429 ELM ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2729
Practice Address - Country:US
Practice Address - Phone:360-734-2182
Practice Address - Fax:360-752-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000123176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095706Medicaid