Provider Demographics
NPI:1902021322
Name:SPIRIT OF LIFE TRADITIONAL MIDWIFERY
Entity Type:Organization
Organization Name:SPIRIT OF LIFE TRADITIONAL MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMS WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:786-287-0484
Mailing Address - Street 1:9745 SW 161ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3315
Mailing Address - Country:US
Mailing Address - Phone:786-287-0484
Mailing Address - Fax:305-235-6688
Practice Address - Street 1:17304 WALKER AVE
Practice Address - Street 2:#116
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-4389
Practice Address - Country:US
Practice Address - Phone:786-287-0484
Practice Address - Fax:305-235-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 141176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340228200Medicaid
FLY005ROtherBLUE CROSS PROVIDER #
FLN205340OtherHEALTHEASE PROVIDER #