Healthcare Provider Details

I. General information

NPI: 1124641642
Provider Name (Legal Business Name): ASTORIA BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 MARINE DR
ASTORIA OR
97103-3808
US

IV. Provider business mailing address

1170 JEROME AVE
ASTORIA OR
97103-4023
US

V. Phone/Fax

Practice location:
  • Phone: 509-539-3985
  • Fax:
Mailing address:
  • Phone: 509-539-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REBECKAH MARIE ORTON
Title or Position: MANAGER
Credential:
Phone: 509-539-3985