Provider Demographics
NPI:1174389910
Name:MIRACLE MOMENTS MIDWIFERY
Entity type:Organization
Organization Name:MIRACLE MOMENTS MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CNM
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN CNM
Authorized Official - Phone:620-480-0115
Mailing Address - Street 1:6526 S WARD PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-5962
Mailing Address - Country:US
Mailing Address - Phone:620-480-0115
Mailing Address - Fax:
Practice Address - Street 1:910 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4001
Practice Address - Country:US
Practice Address - Phone:316-361-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical