Healthcare Provider Details

I. General information

NPI: 1982937934
Provider Name (Legal Business Name): CAROL BIRDSONG BMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 IMPERIAL CT
CLOVIS NM
88101-8633
US

IV. Provider business mailing address

PO BOX 28220
SANTA FE NM
87592
US

V. Phone/Fax

Practice location:
  • Phone: 575-791-7751
  • Fax:
Mailing address:
  • Phone: 505-471-5006
  • Fax: 505-820-9220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-08713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: