Healthcare Provider Details

I. General information

NPI: 1144422148
Provider Name (Legal Business Name): NORTHERN NEW MEXICO BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 MAESTAS RD
TAOS NM
87571
US

IV. Provider business mailing address

1331 MAESTAS RD
TAOS NM
87571
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-1216
  • Fax: 575-758-2683
Mailing address:
  • Phone: 575-758-1216
  • Fax: 575-758-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number00405R
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number07038R
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number95297R
License Number StateNM

VIII. Authorized Official

Name: MRS. BOBBIE JEANETTE BOYD
Title or Position: MIDWIFE
Credential: LM CPM
Phone: 575-758-1216