Provider Demographics
NPI:1013269406
Name:CNM
Entity Type:Organization
Organization Name:CNM
Other - Org Name:BIRTH RITE MIDWIFERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:801-566-2952
Mailing Address - Street 1:4749 S HOLLADAY BLVD
Mailing Address - Street 2:REAR
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5420
Mailing Address - Country:US
Mailing Address - Phone:801-566-2952
Mailing Address - Fax:801-931-2006
Practice Address - Street 1:4749 S HOLLADAY BLVD
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-5420
Practice Address - Country:US
Practice Address - Phone:801-566-2952
Practice Address - Fax:801-931-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84597310151261QB0400X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty