MEDICARE: IMMANUEL BIRTH CO., P.A.

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	0011686-002	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366419392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMANUEL BIRTH CO., P.A.

Provider Business Mailing Address
First Line	:	1109 SW TOPEKA BLVD
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66612-1602
Country	:	US
Telephone Number	:	785-232-6950
Fax Number	:	785-232-4722

Provider Business Practice Location Address
First Line	:	1109 SW TOPEKA BLVD
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66612-1602
Country	:	US
Telephone Number	:	785-232-6950
Fax Number	:	785-232-4722

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	KELLY A GREENE
Credential	:
Telephone Number	:	785-232-6950

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	11/05/2025

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