Provider Demographics
NPI:1346472586
Name:WELL ROUNDED MIDWIFERY
Entity Type:Organization
Organization Name:WELL ROUNDED MIDWIFERY
Other - Org Name:WELL ROUNDED BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MIDWIFE
Authorized Official - Phone:540-382-3031
Mailing Address - Street 1:4725 DRY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6303
Mailing Address - Country:US
Mailing Address - Phone:540-382-3031
Mailing Address - Fax:
Practice Address - Street 1:4725 DRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-6303
Practice Address - Country:US
Practice Address - Phone:540-382-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELL ROUNDED BIRTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-21
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000042176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty