MEDICARE: THE CENTER FOR BIRTH, 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	261QB0400X	Birthing Clinic/Center	FBC-016	AK

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	:	1447642046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR BIRTH, LLC

Provider Business Mailing Address
First Line	:	780 S SNODGRASS DR
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-9149
Country	:	US
Telephone Number	:	907-357-7781
Fax Number	:	907-357-7786

Provider Business Practice Location Address
First Line	:	780 S SNODGRASS DR
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-9149
Country	:	US
Telephone Number	:	907-357-7781
Fax Number	:	907-357-7786

Authorized Official
Title or Position	:	MIDWIFE (CDM)
Name	:	TARA ELROD
Credential	:
Telephone Number	:	907-357-7781

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	12/22/2016

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Directions to “THE CENTER FOR BIRTH, LLC ” Practice Location

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