Provider Demographics
NPI:1922662725
Name:PREMIER BIRTH CENTER CHANTILLY LLC
Entity Type:Organization
Organization Name:PREMIER BIRTH CENTER CHANTILLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-709-1737
Mailing Address - Street 1:4200A TECHNOLOGY CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1214
Mailing Address - Country:US
Mailing Address - Phone:540-709-1737
Mailing Address - Fax:866-611-3615
Practice Address - Street 1:4200A TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1214
Practice Address - Country:US
Practice Address - Phone:540-709-1737
Practice Address - Fax:866-611-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing