MEDICARE: NEW LIFE BIRTH CENTER, INC

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	:	1912293655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE BIRTH CENTER, INC

Provider Business Mailing Address
First Line	:	610 S MAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 S MAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-1751
Country	:	US
Telephone Number	:	540-798-4064
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN WINSTEAD
Credential	:	CNM
Telephone Number	:	540-798-4064

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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