Provider Demographics
NPI:1336859438
Name:MODERN MIDWIVES LLC
Entity Type:Organization
Organization Name:MODERN MIDWIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:904-834-1155
Mailing Address - Street 1:830 3RD ST S STE 108
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6674
Mailing Address - Country:US
Mailing Address - Phone:904-834-1155
Mailing Address - Fax:904-431-3557
Practice Address - Street 1:830 3RD ST S STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6674
Practice Address - Country:US
Practice Address - Phone:904-834-1155
Practice Address - Fax:904-431-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No251E00000XAgenciesHome Health