Provider Demographics
NPI:1295211084
Name:ABUNDANCE MIDWIFERY SERVICE
Entity Type:Organization
Organization Name:ABUNDANCE MIDWIFERY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOGLIO SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-968-0749
Mailing Address - Street 1:4204 CLIFFWOOD CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4204 CLIFFWOOD CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7307
Practice Address - Country:US
Practice Address - Phone:512-958-0749
Practice Address - Fax:512-532-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107537367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369146102Medicaid