Provider Demographics
NPI:1285964205
Name:PACHAMAMA BIRTH CENTER
Entity type:Organization
Organization Name:PACHAMAMA BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GURUBACHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALSA
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:512-858-0145
Mailing Address - Street 1:700 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2515
Mailing Address - Country:US
Mailing Address - Phone:512-858-0415
Mailing Address - Fax:888-863-8691
Practice Address - Street 1:700 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-2515
Practice Address - Country:US
Practice Address - Phone:512-858-0415
Practice Address - Fax:888-863-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty