Provider Demographics
NPI:1073815874
Name:DOULA FOUNDATION OF MID-AMERICA, INC.
Entity Type:Organization
Organization Name:DOULA FOUNDATION OF MID-AMERICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-832-9222
Mailing Address - Street 1:1901 E MEADOWMERE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0320
Mailing Address - Country:US
Mailing Address - Phone:417-832-9222
Mailing Address - Fax:417-832-2151
Practice Address - Street 1:2130 N GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4646
Practice Address - Country:US
Practice Address - Phone:417-832-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty