Provider Demographics
NPI:1396341087
Name:THE MIDWIFES KITCHEN CORP
Entity type:Organization
Organization Name:THE MIDWIFES KITCHEN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:928-276-4998
Mailing Address - Street 1:2946 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7704
Mailing Address - Country:US
Mailing Address - Phone:928-276-4998
Mailing Address - Fax:872-215-9578
Practice Address - Street 1:2946 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7704
Practice Address - Country:US
Practice Address - Phone:928-276-4998
Practice Address - Fax:872-215-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130922Medicaid