Healthcare Provider Details

I. General information

NPI: 1437329182
Provider Name (Legal Business Name): NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 HWY 66 SUITE B
EDGEWOOD NM
87015-9104
US

IV. Provider business mailing address

PO BOX 2729
EDGEWOOD NM
87015-2729
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-3100
  • Fax: 505-286-3102
Mailing address:
  • Phone: 505-286-3100
  • Fax: 505-286-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number462
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR25968
License Number StateNM

VIII. Authorized Official

Name: KAREN C LOVETT
Title or Position: PROVIDER/OWNER
Credential: CFNP, CNM
Phone: 505-286-3100