Provider Demographics
NPI:1790295475
Name:BIRTHCARE FACILITY
Entity Type:Organization
Organization Name:BIRTHCARE FACILITY
Other - Org Name:BIRTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:703-549-5070
Mailing Address - Street 1:1501 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2716
Mailing Address - Country:US
Mailing Address - Phone:703-549-5070
Mailing Address - Fax:703-549-4821
Practice Address - Street 1:1501 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2716
Practice Address - Country:US
Practice Address - Phone:703-549-5070
Practice Address - Fax:703-549-4821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRTHCARE AND WOMEN'S HEALTH, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-06
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111566-2017207VX0000X
261QB0400X
VA111566261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477684280OtherINDIVIDUAL
DC1124244397OtherINDIVIDUAL
VA1265797492OtherINDIVIDUAL
VA1588902928OtherINDIVIDUAL
VA1841719366OtherINDIVIDUAL