=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881211290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL COUNTRY BIRTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2020
-----------------------------------------------------
Last Update Date | 07/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1407 N WATER ST
-----------------------------------------------------
City | BURNET
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78611-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-6262
-----------------------------------------------------
Fax | 512-817-4741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1407 N WATER ST
-----------------------------------------------------
City | BURNET
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78611-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-686-6262
-----------------------------------------------------
Fax | 512-817-4741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MIDWIFE
-----------------------------------------------------
Name | MRS. ASHLEY COLLIE
-----------------------------------------------------
Credential | LM CPM
-----------------------------------------------------
Telephone | 512-686-6262
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------