Provider Demographics
NPI:1649142050
Name:GREEN MOUNTAIN BIRTH CENTER, INC
Entity type:Organization
Organization Name:GREEN MOUNTAIN BIRTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPAS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, APRN
Authorized Official - Phone:206-850-3423
Mailing Address - Street 1:903 GOULD HL
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9288
Mailing Address - Country:US
Mailing Address - Phone:206-850-3423
Mailing Address - Fax:
Practice Address - Street 1:903 GOULD HL
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-9288
Practice Address - Country:US
Practice Address - Phone:206-850-3423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty