Provider Demographics
NPI:1003221870
Name:BIRTH @HOME MIDWIFERY SERVICES
Entity type:Organization
Organization Name:BIRTH @HOME MIDWIFERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:WOODARD
Authorized Official - Last Name:OSTERHOLZER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:269-420-0649
Mailing Address - Street 1:2112 RIVERWALK PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80951-9748
Mailing Address - Country:US
Mailing Address - Phone:269-420-0649
Mailing Address - Fax:
Practice Address - Street 1:2112 RIVERWALK PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80951-9748
Practice Address - Country:US
Practice Address - Phone:269-420-0649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR.0000157176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty