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NPI Code Detail

MEDICARE: KATY BIRTH CENTER, LLC

MEDICARE: KATY BIRTH CENTER, 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
1367A00000XAdvanced Practice Midwife256351

General Provider Information

NPI Number : 1861755282
Entity Type Code : Organization
Provider Name (Legal Business Name) : KATY BIRTH CENTER, LLC
Provider Business Mailing Address
First Line : 1002 AVENUE A
Second Line :
City : KATY
State : TX
Zip : 77493-2462
Country : US
Telephone Number : 832-437-5876
Fax Number : 281-391-9081
Provider Business Practice Location Address
First Line : 1002 AVENUE A
Second Line :
City : KATY
State : TX
Zip : 77493-2462
Country : US
Telephone Number : 832-437-5876
Fax Number : 281-391-9081
Authorized Official
Title or Position : DIRECTOR
Name : MRS. CONNIE ROBBIN BLOKKUM
Credential : RN, CNM, ICBLC
Telephone Number : 832-437-5876
Provider Enumeration Date : 06/20/2012
Last Update Date : 06/20/2012

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Directions to “KATY BIRTH CENTER, LLC ” Practice Location

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