Provider Demographics
NPI:1699367425
Name:MIDWIFE REBEKAH LLC
Entity Type:Organization
Organization Name:MIDWIFE REBEKAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:205-234-8172
Mailing Address - Street 1:6477 WATER WORKS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:AL
Mailing Address - Zip Code:35117-3506
Mailing Address - Country:US
Mailing Address - Phone:205-234-8172
Mailing Address - Fax:205-263-6480
Practice Address - Street 1:1240 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2494
Practice Address - Country:US
Practice Address - Phone:205-234-8172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty