Healthcare Provider Details

I. General information

NPI: 1023858040
Provider Name (Legal Business Name): SELAH MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W BROADWAY
EUGENE OR
97401-2869
US

IV. Provider business mailing address

955 LEWIS AVE APT 1
EUGENE OR
97402-4249
US

V. Phone/Fax

Practice location:
  • Phone: 541-621-2672
  • Fax: 541-982-7594
Mailing address:
  • Phone: 541-621-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier500787054
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: LYDIA DOUGLAS
Title or Position: OWNER
Credential: CPM, LDM
Phone: 541-621-2672