MEDICARE: MOTHER'S OWN BIRTH AND WOMEN'S CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1073718607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHER'S OWN BIRTH AND WOMEN'S CENTER, LLC

Provider Business Mailing Address
First Line	:	1715 W DEAN RD
Second Line	:	SUITE C
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9406
Country	:	US
Telephone Number	:	734-847-8100
Fax Number	:	734-847-6824

Provider Business Practice Location Address
First Line	:	1715 W DEAN RD
Second Line	:	SUITE C
City	:	TEMPERANCE
State	:	MI
Zip	:	48182-9406
Country	:	US
Telephone Number	:	734-847-8100
Fax Number	:	734-847-6824

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA R. JOHNSON
Credential	:	CNM
Telephone Number	:	734-847-8100

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	08/22/2020

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