Healthcare Provider Details

I. General information

NPI: 1346081957
Provider Name (Legal Business Name): TBI MIDWIFERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 WESTGATE BLVD STE 110
TACOMA WA
98406-2580
US

IV. Provider business mailing address

802 N YAKIMA AVE APT 2
TACOMA WA
98403-2422
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-8939
  • Fax: 253-761-7492
Mailing address:
  • Phone: 253-951-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MAYNARD
Title or Position: GOVERNOR
Credential: MD
Phone: 253-951-0040