MEDICARE: SPECIAL DELIVERY BIRTH CENTER

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

General Provider Information

NPI Number	:	1801155197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL DELIVERY BIRTH CENTER

Provider Business Mailing Address
First Line	:	4926 E 73RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7007
Country	:	US
Telephone Number	:	918-477-9343
Fax Number	:	918-895-9159

Provider Business Practice Location Address
First Line	:	4926 E 73RD ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-7007
Country	:	US
Telephone Number	:	918-477-9343
Fax Number	:	918-895-9159

Authorized Official
Title or Position	:	CERTIFIED NURSE MIDWIFE/ OWNER
Name	:	MR. PEGGY RUTH COBB
Credential	:	C.P.M., C.N.M.
Telephone Number	:	918-224-1605

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	05/08/2012

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Directions to “SPECIAL DELIVERY BIRTH CENTER ” Practice Location

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