Healthcare Provider Details

I. General information

NPI: 1649142050
Provider Name (Legal Business Name): GREEN MOUNTAIN BIRTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 UPPER MAIN ST
MORRISVILLE VT
05661-9351
US

IV. Provider business mailing address

903 GOULD HL
JOHNSON VT
05656-9288
US

V. Phone/Fax

Practice location:
  • Phone: 206-850-3423
  • Fax:
Mailing address:
  • Phone: 206-850-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MARY LOU KOPAS
Title or Position: BOARD OF DIRECTORS
Credential: CNM, APRN
Phone: 206-850-3423