Healthcare Provider Details

I. General information

NPI: 1528433372
Provider Name (Legal Business Name): ORANGE CITY FERTILITYCARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ALBANY AVE SE
ORANGE CITY IA
51041-1731
US

IV. Provider business mailing address

211 ALBANY AVE SE
ORANGE CITY IA
51041-1731
US

V. Phone/Fax

Practice location:
  • Phone: 712-266-3282
  • Fax:
Mailing address:
  • Phone: 712-266-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARI MICHELLE BEADNER
Title or Position: DIRECTOR
Credential: CFCP
Phone: 712-266-3282