Provider Demographics
NPI:1407229750
Name:ROOTS MIDWIFERY, LLC
Entity Type:Organization
Organization Name:ROOTS MIDWIFERY, LLC
Other - Org Name:ROOTS COMMUNITY BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER, OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-328-7699
Mailing Address - Street 1:1901 44TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-1209
Mailing Address - Country:US
Mailing Address - Phone:612-338-2784
Mailing Address - Fax:
Practice Address - Street 1:1901 44TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-1209
Practice Address - Country:US
Practice Address - Phone:612-338-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing