Provider Demographics
NPI:1487103222
Name:SEEDS OF GRACE MIDWIFERY LLC
Entity type:Organization
Organization Name:SEEDS OF GRACE MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:903-392-0230
Mailing Address - Street 1:902 E PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-7310
Mailing Address - Country:US
Mailing Address - Phone:903-407-4494
Mailing Address - Fax:844-806-5751
Practice Address - Street 1:902 E PINECREST DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-7310
Practice Address - Country:US
Practice Address - Phone:903-407-4494
Practice Address - Fax:844-806-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150051261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing