Basic Information
Provider Information | |||||||||
NPI: | 1437329182 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 2729 | ||||||||
Address2: |   | ||||||||
City: | EDGEWOOD | ||||||||
State: | NM | ||||||||
PostalCode: | 870152729 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5052863100 | ||||||||
FaxNumber: | 5052863102 | ||||||||
Practice Location | |||||||||
Address1: | 1841 HWY 66 | ||||||||
Address2: | SUITE B | ||||||||
City: | EDGEWOOD | ||||||||
State: | NM | ||||||||
PostalCode: | 870159104 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5052863100 | ||||||||
FaxNumber: | 5052863102 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/10/2008 | ||||||||
LastUpdateDate: | 05/20/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LOVETT | ||||||||
AuthorizedOfficialFirstName: | KAREN | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
AuthorizedOfficialTelephone: | 5052863100 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | CFNP, CNM | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 462 | NM | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   | 363LF0000X | R25968 | NM | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | G0889 | 05 | NM |   | MEDICAID | 000G0919 | 05 | NM |   | MEDICAID | 00NM006227 | 01 | NM | BCBS | OTHER | 201032100 | 01 | NM | PRESBYTERIAN | OTHER | 68638 | 01 | NM | PRESBYTERIAN | OTHER |