Provider Demographics
NPI:1750514881
Name:PEND OREILLE MIDWIFERY SERVICES
Entity type:Organization
Organization Name:PEND OREILLE MIDWIFERY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MIDSTOKKE
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:208-263-0776
Mailing Address - Street 1:723 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-263-0776
Mailing Address - Fax:208-263-0772
Practice Address - Street 1:723 PINE STREET
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-263-0776
Practice Address - Fax:208-263-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing