Basic Information
| Provider Information | |||||||||
| NPI: | 1992043996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLOOMIN BABIES BIRTH CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2241 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815017423 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2241 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815017423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705491711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2013 | ||||||||
| LastUpdateDate: | 08/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | KANDIKO | ||||||||
| AuthorizedOfficialFirstName: | PATTY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 9705491711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CNM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QB0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Birthing |
No ID Information.