Healthcare Provider Details

I. General information

NPI: 1447642046
Provider Name (Legal Business Name): THE CENTER FOR BIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 S SNODGRASS DR
PALMER AK
99645-9149
US

IV. Provider business mailing address

780 S SNODGRASS DR
PALMER AK
99645-9149
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-7781
  • Fax: 907-357-7786
Mailing address:
  • Phone: 907-357-7781
  • Fax: 907-357-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberFBC-016
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1016699
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: TARA ELROD
Title or Position: MIDWIFE (CDM)
Credential:
Phone: 907-357-7781