Healthcare Provider Details

I. General information

NPI: 1013444975
Provider Name (Legal Business Name): ORIGIN BIRTH AND HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S LAFAYETTE ST STE 100
ENGLEWOOD CO
80113
US

IV. Provider business mailing address

3535 S LAFAYETTE ST STE 100
ENGLEWOOD CO
80113-3954
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-0600
  • Fax: 303-788-0602
Mailing address:
  • Phone: 303-788-0600
  • Fax: 303-484-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3918-CNM
License Number StateCO

VIII. Authorized Official

Name: TRACY RYAN
Title or Position: MIDWIFE
Credential: CNM
Phone: 720-271-9445