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General NPI Number Information
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NPI Number | 1083990782
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Entity Type | Organization
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Legal Business Name | JUBILEE BIRTH CENTER
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 02/26/2012
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Provider Practice Location Address
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Address Line | 502 S COULTER DR
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City | BRYAN
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State | TX
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Zip | 77803-4740
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Country | US
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Telephone | 979-739-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 4452 JESKE RD
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City | BRENHAM
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State | TX
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Zip | 77833-8081
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Country | US
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Telephone | 979-251-7377
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Fax | 979-251-8357
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Authorized Official
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Title or Position | OWNER, MIDWIFE
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Name | MRS. TONI G KIMPEL
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Credential | CPM, LM
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Telephone | 979-739-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | 150020
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License Number State | TX
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