Provider Demographics
NPI:1437565876
Name:MOMDOC MIDWIVES
Entity Type:Organization
Organization Name:MOMDOC MIDWIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-821-3610
Mailing Address - Street 1:2545 W FRYE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:1760 E PECOS RD STE 516
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3205
Practice Address - Country:US
Practice Address - Phone:480-814-1910
Practice Address - Fax:480-821-3610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS. GOODMAN AND PARTRIDGE OBGYN LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-07
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8263207V00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty