MEDICARE: BIRTH INNATELY, 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	367A00000X	Advanced Practice Midwife	0016-1	MO

General Provider Information

NPI Number	:	1356889356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRTH INNATELY, LLC

Provider Business Mailing Address
First Line	:	3840 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5285
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 SOUTH AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5285
Country	:	US
Telephone Number	:	417-616-3114
Fax Number	:

Authorized Official
Title or Position	:	COO/ADMINISTRATOR
Name	:	SARAH BARKLEY
Credential	:
Telephone Number	:	417-616-3114

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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