Organization
ORIGINS BIRTH AND WELLNESS DALLAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMETHYST FAGAN TATE CPM (MIDWIFE)
(214) 228-1392
Entity
Organization
Contact information
Practice address
3100 SWISS AVE, DALLAS, TX 75204
(214) 228-1392
Mailing address
3100 SWISS AVE, DALLAS, TX 75204-6025
(214) 228-1392
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
99337
TX
261QB0400X
Birthing Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147744198
—
TX
Enumeration date
06/17/2018
Last updated
04/17/2019
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