Provider Demographics
NPI:1649482217
Name:WESTSIDE MIDWIFERY & WOMEN'S HEALTH, PC
Entity type:Organization
Organization Name:WESTSIDE MIDWIFERY & WOMEN'S HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, MS
Authorized Official - Phone:406-723-8051
Mailing Address - Street 1:401 S ALABAMA ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2315
Mailing Address - Country:US
Mailing Address - Phone:406-723-8051
Mailing Address - Fax:406-723-8063
Practice Address - Street 1:401 S ALABAMA ST
Practice Address - Street 2:SUITE 9
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2315
Practice Address - Country:US
Practice Address - Phone:406-723-8051
Practice Address - Fax:406-723-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4302532Medicaid
MT4302530Medicaid
MT000083888Medicare ID - Type UnspecifiedM. RAE FARRELL
MT4302532Medicaid
MT4302530Medicaid
MT000083889Medicare ID - Type UnspecifiedSUSAN E. BURTON