Provider Demographics
NPI:1932334927
Name:EDENWAY BIRTH CENTER
Entity Type:Organization
Organization Name:EDENWAY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:318-272-8295
Mailing Address - Street 1:404 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5262
Mailing Address - Country:US
Mailing Address - Phone:318-272-8295
Mailing Address - Fax:
Practice Address - Street 1:404 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5262
Practice Address - Country:US
Practice Address - Phone:318-272-8295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing