Organization
CREEKSIDE BIRTH COTTAGE
Active
Organization
CREEKSIDE BIRTH COTTAGE
Active
Parent organization
CREEKSIDE MIDWIFERY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CREEKSIDE MIDWIFERY LLC
Authorized official
LACEY TACKETT (MEMBER)
(928) 951-6410
Entity
Organization
Contact information
Practice address
215 W FRONTIER ST, PAYSON, AZ 85541-5318
(928) 951-6410
Mailing address
215 W FRONTIER ST, PAYSON, AZ 85541-5318
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
Other
Enumeration date
09/12/2023
Last updated
09/12/2023
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