Healthcare Provider Details

I. General information

NPI: 1003206954
Provider Name (Legal Business Name): MOUNTAIN MIRACLES MIDWIFERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 LEHMAN DR STE 103
COLORADO SPRINGS CO
80918-3459
US

IV. Provider business mailing address

PO BOX 7875
COLORADO SPRINGS CO
80933-7875
US

V. Phone/Fax

Practice location:
  • Phone: 719-306-2140
  • Fax:
Mailing address:
  • Phone: 719-306-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY JORGENSON
Title or Position: PRESIDENT
Credential: MSN, CNM
Phone: 719-306-2140