=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972301455
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CACHE VALLEY BIRTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 06/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2380 N 400 E STE D
-----------------------------------------------------
City | NORTH LOGAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84341-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-232-3286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2885 S 5900 W
-----------------------------------------------------
City | MENDON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84325-9789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JAMESON HEPNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 435-232-3286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------