Healthcare Provider Details

I. General information

NPI: 1871088039
Provider Name (Legal Business Name): KLAMATH BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 MAIN ST
KLAMATH FALLS OR
97601-2636
US

IV. Provider business mailing address

1803 MAIN ST
KLAMATH FALLS OR
97601-2636
US

V. Phone/Fax

Practice location:
  • Phone: 907-388-9876
  • Fax:
Mailing address:
  • Phone: 907-388-9876
  • 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: BETHANY MCKINNON
Title or Position: OWNER
Credential: CPM, LDM
Phone: 907-388-9876