Provider Demographics
NPI:1386949170
Name:TRADITIONAL MIDWIFERY OF LYNCHBURG, LLC
Entity type:Organization
Organization Name:TRADITIONAL MIDWIFERY OF LYNCHBURG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-384-9602
Mailing Address - Street 1:1525 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2406
Mailing Address - Country:US
Mailing Address - Phone:434-384-9602
Mailing Address - Fax:434-384-9603
Practice Address - Street 1:1525 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2406
Practice Address - Country:US
Practice Address - Phone:434-384-9602
Practice Address - Fax:434-384-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000001176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty