Healthcare Provider Details

I. General information

NPI: 1235529223
Provider Name (Legal Business Name): MIDVALLEY BIRTHING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 SANTIAM HWY SE SUITE H
ALBANY OR
97322-5293
US

IV. Provider business mailing address

2532 SANTIAM HWY SE #314
ALBANY OR
97322-5211
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-1002
  • Fax: 541-981-2072
Mailing address:
  • Phone: 541-928-1002
  • Fax: 541-981-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10156108
License Number StateOR

VIII. Authorized Official

Name: JULIA MAY BAILEY
Title or Position: OWNER
Credential: CPM, LDM
Phone: 541-928-1002