Provider Demographics
NPI:1013232404
Name:NEW VILLAGE MIDWIVES LLC
Entity Type:Organization
Organization Name:NEW VILLAGE MIDWIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MIDWIFE
Authorized Official - Phone:573-447-0282
Mailing Address - Street 1:3406 N MOREAU RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-8618
Mailing Address - Country:US
Mailing Address - Phone:573-447-0280
Mailing Address - Fax:573-447-0282
Practice Address - Street 1:1114 SUNSET LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2253
Practice Address - Country:US
Practice Address - Phone:573-356-1059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty