MEDICARE: INDIANA BIRTH CENTER WEST

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1912758053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA BIRTH CENTER WEST

Provider Business Mailing Address
First Line	:	6620 PARKDALE PL STE K
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 PARKDALE PL STE K
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4697
Country	:	US
Telephone Number	:	317-437-3671
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SAM CROSTON
Credential	:
Telephone Number	:	630-290-0090

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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Directions to “INDIANA BIRTH CENTER WEST ” Practice Location

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