Provider Demographics
NPI:1609647882
Name:HERITAGE MATERNITY SERVICES
Entity type:Organization
Organization Name:HERITAGE MATERNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOSO
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:979-571-4490
Mailing Address - Street 1:10387 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-4139
Mailing Address - Country:US
Mailing Address - Phone:979-571-4490
Mailing Address - Fax:
Practice Address - Street 1:10387 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-4139
Practice Address - Country:US
Practice Address - Phone:979-571-4490
Practice Address - Fax:979-318-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154016950Medicaid
TX1801421490Medicaid