Healthcare Provider Details

I. General information

NPI: 1992839781
Provider Name (Legal Business Name): CYNTHIA J. LUXFORD LDM-CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 N. NORTHBANK ROAD
OTIS OR
97368
US

IV. Provider business mailing address

3013 N. NORTHBANK ROAD
OTIS OR
97368
US

V. Phone/Fax

Practice location:
  • Phone: 541-996-3968
  • Fax: 541-996-6353
Mailing address:
  • Phone: 541-996-3968
  • Fax: 541-996-6353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number07-1569
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number594879
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier140025
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
Identifier213447
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: