Provider Demographics
NPI:1831301415
Name:NEW LIFE BIRTH SERVICES, INC.
Entity Type:Organization
Organization Name:NEW LIFE BIRTH SERVICES, INC.
Other - Org Name:NEW LIFE BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIMIKEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN, LM, CPM
Authorized Official - Phone:512-477-5452
Mailing Address - Street 1:9302 CASTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6010
Mailing Address - Country:US
Mailing Address - Phone:512-477-5452
Mailing Address - Fax:512-477-5716
Practice Address - Street 1:9302 CASTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6010
Practice Address - Country:US
Practice Address - Phone:512-477-5452
Practice Address - Fax:512-477-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232731163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-RiskGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER