=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417109901
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL PA BIRTH AND BREASTFEEDING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2008
-----------------------------------------------------
Last Update Date | 10/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3808 CHIPPENHAM RD
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-385-7925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3808 CHIPPENHAM RD
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050-2198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-385-7925
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, DEM
-----------------------------------------------------
Name | MRS. BARBARA MYREE CAVANAUGH
-----------------------------------------------------
Credential | DEM, OWNER
-----------------------------------------------------
Telephone | 717-385-7925
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------