MEDICARE: MOBILE MIDWIFE, INC

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	176B00000X	Midwife	MW208	FL

General Provider Information

NPI Number	:	1164662748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE MIDWIFE, INC

Provider Business Mailing Address
First Line	:	930 NE 205TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-1918
Country	:	US
Telephone Number	:	786-975-9222
Fax Number	:	786-513-0380

Provider Business Practice Location Address
First Line	:	12945 W DIXIE HWY
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-4809
Country	:	US
Telephone Number	:	786-975-9222
Fax Number	:	786-513-0380

Authorized Official
Title or Position	:	LICENSED MIDWIFE
Name	:	MRS. ADA REBECA SPROUSE
Credential	:
Telephone Number	:	786-975-9222

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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Directions to “MOBILE MIDWIFE, INC ” Practice Location

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