Provider Demographics
NPI:1447764899
Name:MISSOURI MIDWIFERY SERVICE
Entity Type:Organization
Organization Name:MISSOURI MIDWIFERY SERVICE
Other - Org Name:BIRTH CENTERED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CNM, APRN/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:VEE
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-616-3114
Mailing Address - Street 1:3840 SOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-616-3114
Mailing Address - Fax:417-720-4815
Practice Address - Street 1:3840 SOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-616-3114
Practice Address - Fax:720-829-8517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAROCHIAL HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-21
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing