Provider Demographics
NPI:1609307735
Name:MAGNOLIA BIRTH CENTER - MIDWIFERY & WOMEN'S HEALTH
Entity Type:Organization
Organization Name:MAGNOLIA BIRTH CENTER - MIDWIFERY & WOMEN'S HEALTH
Other - Org Name:MAGNOLIA BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:336-456-3896
Mailing Address - Street 1:2122 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7004
Mailing Address - Country:US
Mailing Address - Phone:336-763-5123
Mailing Address - Fax:
Practice Address - Street 1:2122 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7004
Practice Address - Country:US
Practice Address - Phone:336-763-5123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing