Provider Demographics
NPI:1679006241
Name:WASATCH MIDWIFERY CENTER, LLC
Entity Type:Organization
Organization Name:WASATCH MIDWIFERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-237-1568
Mailing Address - Street 1:6440 S WASATCH BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3511
Mailing Address - Country:US
Mailing Address - Phone:385-237-1568
Mailing Address - Fax:385-557-5623
Practice Address - Street 1:6440 S WASATCH BLVD STE 140
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:385-237-1568
Practice Address - Fax:385-557-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2017-BC-UT000826261QB0400X
UT67268187100175F00000X
UT7822984-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty