MEDICARE: SAN ANTONIO NURSE MIDWIFE BIRTH AND WELLNESS CENTER INC

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	367A00000X	Advanced Practice Midwife
2	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1821621319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO NURSE MIDWIFE BIRTH AND WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	20328 FM 2252
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2614
Country	:	US
Telephone Number	:	210-901-9082
Fax Number	:

Provider Business Practice Location Address
First Line	:	20328 FM 2252
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78266-2614
Country	:	US
Telephone Number	:	210-901-9082
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANECHIA N MCIVER-BROWN
Credential	:	CNM
Telephone Number	:	210-365-3011

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	02/14/2020

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