MEDICARE: RIVER CITY BIRTH 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

General Provider Information

NPI Number	:	1891359550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY BIRTH CENTER

Provider Business Mailing Address
First Line	:	6219 LAKESIDE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5238
Country	:	US
Telephone Number	:	804-601-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	6219 LAKESIDE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-5238
Country	:	US
Telephone Number	:	804-601-6992
Fax Number	:

Authorized Official
Title or Position	:	MIDWIFE
Name	:	MRS. LINSEY KORNYA
Credential	:	CPM
Telephone Number	:	804-601-6992

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	04/29/2019

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Directions to “RIVER CITY BIRTH CENTER ” Practice Location

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