Provider Demographics
NPI:1801299128
Name:WILLOW MIDWIVES LTD
Entity type:Organization
Organization Name:WILLOW MIDWIVES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:HEITKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-345-5920
Mailing Address - Street 1:3033 EXCELSIOR BLVD STE 585
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-6400
Mailing Address - Country:US
Mailing Address - Phone:612-345-5920
Mailing Address - Fax:844-562-6828
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 585
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4688
Practice Address - Country:US
Practice Address - Phone:952-212-6801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31316261QB0400X
261QF0050X, 261QA0005X, 261QH0700X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning FacilityGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801299128Medicaid