MEDICARE: B2 HEALTHCARE GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	2084P0804X	Child & Adolescent Psychiatry Physician
4	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1891318747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B2 HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	PO BOX 16196
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87191-6196
Country	:	US
Telephone Number	:	505-480-5156
Fax Number	:	505-639-4145

Provider Business Practice Location Address
First Line	:	8204 LOUISIANA BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1737
Country	:	US
Telephone Number	:	505-582-2180
Fax Number	:	505-639-4145

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AVA A BOSWELL
Credential	:	MD
Telephone Number	:	505-480-5156

Provider Enumeration Date	:	05/27/2020
Last Update Date	:	04/25/2022

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