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NPI Code Detail

MEDICARE: ROOTS MIDWIFERY, LLC

MEDICARE: ROOTS 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
1261QB0400XBirthing Clinic/Center

General Provider Information

NPI Number : 1407229750
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOTS MIDWIFERY, LLC
Provider Business Mailing Address
First Line : 1901 44TH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1209
Country : US
Telephone Number : 612-338-2784
Fax Number :
Provider Business Practice Location Address
First Line : 1901 44TH AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55412-1209
Country : US
Telephone Number : 612-338-2784
Fax Number :
Authorized Official
Title or Position : BILLER, OFFICE ADMIN
Name : MELANIE GRAY
Credential :
Telephone Number : 651-328-7699
Provider Enumeration Date : 11/09/2015
Last Update Date : 11/09/2015

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Directions to “ROOTS MIDWIFERY, LLC ” Practice Location

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