Healthcare Provider Details

I. General information

NPI: 1053091843
Provider Name (Legal Business Name): OBS HOME BIRTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 ALTA VISTA RD
FORT WORTH TX
76244-6501
US

IV. Provider business mailing address

10345 ALTA VISTA RD
FORT WORTH TX
76244-6501
US

V. Phone/Fax

Practice location:
  • Phone: 817-562-2828
  • Fax:
Mailing address:
  • Phone: 817-562-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AME COCHENOUR
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 817-703-7509