Healthcare Provider Details

I. General information

NPI: 1659542579
Provider Name (Legal Business Name): MOUNTAIN MIDWIFERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S LAFAYETTE ST SUITE 100
ENGLEWOOD CO
80113-3957
US

IV. Provider business mailing address

3535 S LAFAYETTE ST SUITE 100
ENGLEWOOD CO
80113-3957
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-0600
  • Fax: 303-788-0602
Mailing address:
  • Phone: 303-788-0600
  • Fax: 303-788-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number40G369
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL L RYAN
Title or Position: OWNER
Credential: MS
Phone: 303-788-0600