Provider Demographics
NPI:1720596901
Name:THE ADDICE BIRTH CENTER, LLC
Entity Type:Organization
Organization Name:THE ADDICE BIRTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-205-0770
Mailing Address - Street 1:2408 TIMBERLOCH PL STE A4
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1042
Mailing Address - Country:US
Mailing Address - Phone:832-205-4884
Mailing Address - Fax:
Practice Address - Street 1:8845 SIX PINES DR STE 150
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2675
Practice Address - Country:US
Practice Address - Phone:832-205-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing