=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114351293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NATURAL BIRTHING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2013
-----------------------------------------------------
Last Update Date | 11/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 N MAIN ST
-----------------------------------------------------
City | SALADO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76571-6137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-818-6791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 COUNTY ROAD 238
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78633-4612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-818-6791
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNM-RN, CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. SANDRA KAY TALLBEAR
-----------------------------------------------------
Credential | CERTIFIED NURSE MIDW
-----------------------------------------------------
Telephone | 512-818-6791
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number | 150032
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------