Provider Demographics
NPI:1043946460
Name:OREGON BIRTH CENTER, LLC
Entity Type:Organization
Organization Name:OREGON BIRTH CENTER, LLC
Other - Org Name:ANDALUZ BIRTH CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-793-2676
Mailing Address - Street 1:3323 SW NAITO PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4672
Mailing Address - Country:US
Mailing Address - Phone:503-885-0228
Mailing Address - Fax:
Practice Address - Street 1:3323 SW NAITO PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4672
Practice Address - Country:US
Practice Address - Phone:503-885-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR07-1672OtherBIRTH CENTER