Provider Demographics
NPI:1861193807
Name:OCEANSIDE MIDWIVES
Entity type:Organization
Organization Name:OCEANSIDE MIDWIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TREPICCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:843-273-6304
Mailing Address - Street 1:802 41ST AVE S STE 109
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5155
Mailing Address - Country:US
Mailing Address - Phone:843-273-6304
Mailing Address - Fax:843-419-8818
Practice Address - Street 1:802 41ST AVE S # 109
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-5155
Practice Address - Country:US
Practice Address - Phone:843-273-6304
Practice Address - Fax:843-419-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW90905SC1Medicaid