Provider Demographics
NPI:1740956150
Name:MIDWIFE KIRA
Entity type:Organization
Organization Name:MIDWIFE KIRA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BIRTH CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-453-4346
Mailing Address - Street 1:803 S MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4921
Mailing Address - Country:US
Mailing Address - Phone:337-453-4346
Mailing Address - Fax:337-735-3967
Practice Address - Street 1:715 COOLIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2309
Practice Address - Country:US
Practice Address - Phone:337-412-4373
Practice Address - Fax:337-735-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty