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NPI Code Detail

MEDICARE: AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC

MEDICARE: AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QB0400XBirthing Clinic/Center

General Provider Information

NPI Number : 1174323836
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC
Provider Business Mailing Address
First Line : 2864 S WAUKESHA RD
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2834
Country : US
Telephone Number : 414-617-3178
Fax Number :
Provider Business Practice Location Address
First Line : 530 N 108TH PL STE 100
Second Line :
City : WAUWATOSA
State : WI
Zip : 53226-4253
Country : US
Telephone Number : 414-231-9640
Fax Number : 414-226-5078
Authorized Official
Title or Position : COO
Name : TONY SKARLATOS
Credential :
Telephone Number : 414-617-3178
Provider Enumeration Date : 03/13/2025
Last Update Date : 12/19/2025

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Directions to “AUTHENTIC BIRTH CENTER WELLNESS COLLECTIVE LLC ” Practice Location

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