1437329182 NPI number — NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.

Table of content: (NPI 1437329182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437329182 NPI number — NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437329182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87015-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-286-3100
Provider Business Mailing Address Fax Number:
505-286-3102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1841 HWY 66
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87015-9104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-286-3100
Provider Business Practice Location Address Fax Number:
505-286-3102
Provider Enumeration Date:
03/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOVETT
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PROVIDER/OWNER
Authorized Official Telephone Number:
505-286-3100

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R25968 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 462 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G0889 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000G0919 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00NM006227 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 201032100 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 68638 . This is a "PRESBYTERIAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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