Provider Demographics
NPI:1871870949
Name:RIVERSIDE MIDWIFERY, LLC
Entity type:Organization
Organization Name:RIVERSIDE MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:240-341-4974
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:BUCKEYSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21717-0069
Mailing Address - Country:US
Mailing Address - Phone:240-341-4974
Mailing Address - Fax:304-461-6522
Practice Address - Street 1:3620 BUCKEYSTOWN PIKE POST BOX 69
Practice Address - Street 2:
Practice Address - City:BUCKEYSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21717-0069
Practice Address - Country:US
Practice Address - Phone:240-341-4974
Practice Address - Fax:304-461-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service