Provider Demographics
NPI:1083158141
Name:PLANO BIRTH PLACE
Entity Type:Organization
Organization Name:PLANO BIRTH PLACE
Other - Org Name:PLANO BIRTHPLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:TATE,
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CNM
Authorized Official - Phone:469-912-0727
Mailing Address - Street 1:5172 VILLAGE CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4444
Mailing Address - Country:US
Mailing Address - Phone:469-912-0727
Mailing Address - Fax:
Practice Address - Street 1:5172 VILLAGE CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4444
Practice Address - Country:US
Practice Address - Phone:469-912-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing