Provider Demographics
NPI:1700422870
Name:ROANOKE BIRTH AND PERINATAL CENTER
Entity Type:Organization
Organization Name:ROANOKE BIRTH AND PERINATAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:540-855-7913
Mailing Address - Street 1:1950 ELECTRIC RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1621
Mailing Address - Country:US
Mailing Address - Phone:540-302-8051
Mailing Address - Fax:540-301-1768
Practice Address - Street 1:1950 ELECTRIC RD STE 1
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1621
Practice Address - Country:US
Practice Address - Phone:540-302-8051
Practice Address - Fax:540-301-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty