Provider Demographics
NPI:1023858040
Name:SELAH MIDWIFERY
Entity type:Organization
Organization Name:SELAH MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDM
Authorized Official - Phone:541-621-2672
Mailing Address - Street 1:955 LEWIS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4249
Mailing Address - Country:US
Mailing Address - Phone:541-621-2672
Mailing Address - Fax:
Practice Address - Street 1:395 W BROADWAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2869
Practice Address - Country:US
Practice Address - Phone:541-621-2672
Practice Address - Fax:541-982-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500787054Medicaid