MEDICARE: NORTHEAST TEXAS MIDWIFERY PLLC

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	:	1184396665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST TEXAS MIDWIFERY PLLC

Provider Business Mailing Address
First Line	:	413 W 1ST ST
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-4334
Country	:	US
Telephone Number	:	903-708-2004
Fax Number	:	903-767-4499

Provider Business Practice Location Address
First Line	:	413 W 1ST ST
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-4334
Country	:	US
Telephone Number	:	903-708-2004
Fax Number	:	903-767-4499

Authorized Official
Title or Position	:	CEO
Name	:	DIANE DREIER
Credential	:	LM
Telephone Number	:	903-574-7646

Provider Enumeration Date	:	10/02/2021
Last Update Date	:	09/02/2025

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