Provider Demographics
NPI:1336823970
Name:MAPLE MOUNTAIN BIRTH CENTER
Entity Type:Organization
Organization Name:MAPLE MOUNTAIN BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:PENDLETON
Authorized Official - Last Name:DICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:801-836-4559
Mailing Address - Street 1:990 E 400 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3671
Mailing Address - Country:US
Mailing Address - Phone:801-836-4559
Mailing Address - Fax:801-206-3977
Practice Address - Street 1:144 W 1900 N STE 100
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-9524
Practice Address - Country:US
Practice Address - Phone:801-836-4559
Practice Address - Fax:801-206-3977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing