Healthcare Provider Details

I. General information

NPI: 1841055803
Provider Name (Legal Business Name): BIRTH CENTER OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MYRTLE RIDGE RD
LUTZ FL
33549-5632
US

IV. Provider business mailing address

106 MYRTLE RIDGE RD
LUTZ FL
33549-5632
US

V. Phone/Fax

Practice location:
  • Phone: 813-949-1185
  • Fax: 813-949-1162
Mailing address:
  • Phone: 813-949-1185
  • Fax: 813-949-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAM CROSTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 630-290-0090