Provider Demographics
NPI:1164662748
Name:MOBILE MIDWIFE, INC
Entity Type:Organization
Organization Name:MOBILE MIDWIFE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:REBECA
Authorized Official - Last Name:SPROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-975-9222
Mailing Address - Street 1:930 NE 205TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1918
Mailing Address - Country:US
Mailing Address - Phone:786-975-9222
Mailing Address - Fax:786-513-0380
Practice Address - Street 1:12945 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-4809
Practice Address - Country:US
Practice Address - Phone:786-975-9222
Practice Address - Fax:786-513-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW208176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty