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General NPI Number Information
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NPI Number | 1861617540
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Entity Type | Organization
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Legal Business Name | AVANLEE BIRTH AND MATERNITY CENTER
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 811 S W S YOUNG DR
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City | KILLEEN
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State | TX
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Zip | 76543-4801
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Country | US
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Telephone | 254-690-5900
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Fax | 254-690-5908
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Provider Business Mailing Address
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Address Line | 811 S W S YOUNG DR
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City | KILLEEN
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State | TX
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Zip | 76543-4801
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Country | US
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Telephone | 254-690-5900
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Fax | 254-690-5908
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JONATHAN GRAHAM BENNETT
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Credential |
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Telephone | 254-690-5900
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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 | 008360
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License Number State | TX
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