Provider Demographics
NPI:1235276494
Name:MOUNTAIN MIDWIFERY CENTER, INC.
Entity Type:Organization
Organization Name:MOUNTAIN MIDWIFERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:303-788-0600
Mailing Address - Street 1:3555 S CLARKSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3909
Mailing Address - Country:US
Mailing Address - Phone:303-788-0600
Mailing Address - Fax:303-788-0602
Practice Address - Street 1:3555 S CLARKSON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3909
Practice Address - Country:US
Practice Address - Phone:303-788-0600
Practice Address - Fax:303-788-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0159261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40G369OtherSTATE LICENSE NUMBER
CO63674351Medicaid