MEDICARE: BLESSED EVENTS MIDWIFERY, 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	176B00000X	Midwife	MID-25	ID

General Provider Information

NPI Number	:	1356691505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED EVENTS MIDWIFERY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 227
Second Line	:
City	:	SANTA
State	:	ID
Zip	:	83866
Country	:	US
Telephone Number	:	208-245-5712
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 JOANS ROAD
Second Line	:
City	:	SANTA
State	:	ID
Zip	:	83866
Country	:	US
Telephone Number	:	208-245-5712
Fax Number	:

Authorized Official
Title or Position	:	MIDWIFE/OWNER
Name	:	TERRY RAE ROGERS
Credential	:	LM, CPM
Telephone Number	:	208-245-5712

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	09/14/2012

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