Healthcare Provider Details

I. General information

NPI: 1992955678
Provider Name (Legal Business Name): MOUNTAIN VIEW MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 ROSE HILL DR STE 1
CHARLOTTESVILLE VA
22903-5168
US

IV. Provider business mailing address

1111 ROSE HILL DR STE 1
CHARLOTTESVILLE VA
22903-5168
US

V. Phone/Fax

Practice location:
  • Phone: 434-962-0148
  • Fax: 434-566-0133
Mailing address:
  • Phone: 434-962-0148
  • Fax: 434-566-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000003
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000005
License Number StateVA

VIII. Authorized Official

Name: DR. DEREN BADER
Title or Position: PARTNER
Credential: CPM, DRPH
Phone: 434-962-0148