Provider Demographics
NPI:1134344096
Name:LOVERS LANE BIRTH CENTER
Entity type:Organization
Organization Name:LOVERS LANE BIRTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WARANCH
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:214-366-3579
Mailing Address - Street 1:304 S COTTONWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5752
Mailing Address - Country:US
Mailing Address - Phone:214-366-3579
Mailing Address - Fax:214-366-3580
Practice Address - Street 1:304 S COTTONWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5752
Practice Address - Country:US
Practice Address - Phone:214-366-3579
Practice Address - Fax:214-366-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007294261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24DUOtherBLUE CROSS BLUE SHIELD
TX00404EMedicare UPIN
TXS69508Medicare UPIN