Provider Demographics
NPI:1770910721
Name:MIDWIVES COOPERATIVE LLC
Entity type:Organization
Organization Name:MIDWIVES COOPERATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS-REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:352-377-3879
Mailing Address - Street 1:5310 NW 8TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4468
Mailing Address - Country:US
Mailing Address - Phone:352-377-3879
Mailing Address - Fax:352-478-0175
Practice Address - Street 1:5310 NW 8TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4468
Practice Address - Country:US
Practice Address - Phone:352-377-3879
Practice Address - Fax:386-462-9021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121972500Medicaid