Provider Demographics
NPI:1740307206
Name:SERAPHINE BIRTH CENTER AND FAMILY CLINICS
Entity type:Organization
Organization Name:SERAPHINE BIRTH CENTER AND FAMILY CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WENDELL
Authorized Official - Last Name:GNEITING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:801-936-6966
Mailing Address - Street 1:PO BOX 71218
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0218
Mailing Address - Country:US
Mailing Address - Phone:801-963-6966
Mailing Address - Fax:801-963-6366
Practice Address - Street 1:6216 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-6630
Practice Address - Country:US
Practice Address - Phone:801-963-6966
Practice Address - Fax:801-963-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52779300151261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care