Provider Demographics
NPI:1427114040
Name:MOUNTAIN LAUREL MIDWIFERY ASSOCIATES PA
Entity type:Organization
Organization Name:MOUNTAIN LAUREL MIDWIFERY ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KING
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:828-248-1990
Mailing Address - Street 1:218 DOGGETT RD
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-8203
Mailing Address - Country:US
Mailing Address - Phone:828-248-1990
Mailing Address - Fax:828-248-1198
Practice Address - Street 1:218 DOGGETT RD
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-8203
Practice Address - Country:US
Practice Address - Phone:828-248-1990
Practice Address - Fax:828-248-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC080176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000081Medicaid
NC1109MOtherBCBSNC PROVIDER #
NC7000033OtherMEDICAID GROUP #
NC7000033OtherMEDICAID GROUP #
NC1109MOtherBCBSNC PROVIDER #
NC7000081Medicaid