=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265229413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA BIRTH CENTER PMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2025
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 COMMONS WAY
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29611-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-329-0010
-----------------------------------------------------
Fax | 864-373-9063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 COMMONS WAY
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29611-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-329-0010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED MEMBER
-----------------------------------------------------
Name | CYNTHIA GLENN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-329-0010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------