=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740681501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTNEY MADDOX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2014
-----------------------------------------------------
Last Update Date | 09/11/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 E PINECREST DR
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75670-7310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-272-8295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 E PINECREST DR
-----------------------------------------------------
City | MARSHALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75670-7310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | MDW200012
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 99208
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------