MEDICARE: LABOR OF LOVE 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
1	261QB0400X	Birthing Clinic/Center	FBC-014	AK
2	175M00000X	Lay Midwife	NM0044	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	:	1821399460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABOR OF LOVE MIDWIFERY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 874486
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99587-4486
Country	:	US
Telephone Number	:	907-841-2565
Fax Number	:	888-862-1422

Provider Business Practice Location Address
First Line	:	2405 S. KNIK GOOSE BAY ROAD
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654
Country	:	US
Telephone Number	:	907-841-2565
Fax Number	:	888-862-1422

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. PEGGY JEAN HALSEY
Credential	:	CDM, CPM
Telephone Number	:	907-841-2565

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	03/23/2018

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