Provider Demographics
NPI:1174805808
Name:GROWING FAMILIES MIDWIFERY SERVICE AND BIRTH CENTER
Entity type:Organization
Organization Name:GROWING FAMILIES MIDWIFERY SERVICE AND BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALZER
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:904-460-2771
Mailing Address - Street 1:3750 US 1 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7150
Mailing Address - Country:US
Mailing Address - Phone:904-460-2771
Mailing Address - Fax:904-460-2711
Practice Address - Street 1:3750 US 1 S
Practice Address - Street 2:SUITE A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7150
Practice Address - Country:US
Practice Address - Phone:904-460-2771
Practice Address - Fax:904-460-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL338261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing