Provider Demographics
NPI:1306086855
Name:COUNTRY LIFE MIDWIFERY SERVICES
Entity type:Organization
Organization Name:COUNTRY LIFE MIDWIFERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFERY
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:YVONE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:615-646-7300
Mailing Address - Street 1:4554 HILLTOP ROAD
Mailing Address - Street 2:
Mailing Address - City:PEGRAM
Mailing Address - State:TN
Mailing Address - Zip Code:37143
Mailing Address - Country:US
Mailing Address - Phone:615-646-7300
Mailing Address - Fax:615-646-7331
Practice Address - Street 1:4554 HILLTOP ROAD
Practice Address - Street 2:
Practice Address - City:PEGRAM
Practice Address - State:TN
Practice Address - Zip Code:37143
Practice Address - Country:US
Practice Address - Phone:615-646-7300
Practice Address - Fax:615-646-7331
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTYLE MINISTRIES INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000007176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty