Provider Demographics
NPI:1437771755
Name:INDIAN CREEK MIDWIFERY & BIRTH CENTER, PLLC
Entity Type:Organization
Organization Name:INDIAN CREEK MIDWIFERY & BIRTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFERY DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:607-379-9606
Mailing Address - Street 1:574 S DANBY RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NY
Mailing Address - Zip Code:14883-9606
Mailing Address - Country:US
Mailing Address - Phone:607-379-9606
Mailing Address - Fax:
Practice Address - Street 1:132 INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1331
Practice Address - Country:US
Practice Address - Phone:607-793-3794
Practice Address - Fax:607-821-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing