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	176B00000X	Midwife

General Provider Information

NPI Number	:	1295592509
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	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-4334
Country	:	US
Telephone Number	:	903-574-7646
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 D DREIER
Credential	:
Telephone Number	:	903-708-2004

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	08/15/2025

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