Provider Demographics
NPI:1831844760
Name:LYNDEN BIRTH CENTER
Entity type:Organization
Organization Name:LYNDEN BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM, MA
Authorized Official - Phone:360-510-0188
Mailing Address - Street 1:200 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1411
Mailing Address - Country:US
Mailing Address - Phone:360-510-0188
Mailing Address - Fax:844-411-7474
Practice Address - Street 1:200 3RD ST
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1411
Practice Address - Country:US
Practice Address - Phone:360-510-0188
Practice Address - Fax:844-411-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2109294Medicaid