Provider Demographics
NPI:1578261178
Name:FULL CIRCLE WELLNESS & BIRTHCENTER LLC
Entity Type:Organization
Organization Name:FULL CIRCLE WELLNESS & BIRTHCENTER LLC
Other - Org Name:FULL CIRCLE BIRTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-212-6801
Mailing Address - Street 1:603 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944
Mailing Address - Country:US
Mailing Address - Phone:507-634-6071
Mailing Address - Fax:
Practice Address - Street 1:603 3RD AVE SE-BIRTHCENTER
Practice Address - Street 2:
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-5594
Practice Address - Country:US
Practice Address - Phone:507-634-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1234567OtherMDH BIRTH CENTER LICENSE