MEDICARE: BEYOND THE HORIZON PRENATAL CARE CENTER

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
1	261QB0400X	Birthing Clinic/Center
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1861195356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND THE HORIZON PRENATAL CARE CENTER

Provider Business Mailing Address
First Line	:	5401 N 76TH ST STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-2746
Country	:	US
Telephone Number	:	414-317-6435
Fax Number	:	414-210-4302

Provider Business Practice Location Address
First Line	:	5401 N 76TH ST STE 101
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-2746
Country	:	US
Telephone Number	:	414-317-6435
Fax Number	:	414-210-4302

Authorized Official
Title or Position	:	OWNER
Name	:	DOMANIKA J WALTON
Credential	:	MA
Telephone Number	:	414-394-0793

Provider Enumeration Date	:	03/23/2023
Last Update Date	:	04/05/2023

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