Provider Demographics
NPI:1003206954
Name:MOUNTAIN MIRACLES MIDWIFERY, INC.
Entity Type:Organization
Organization Name:MOUNTAIN MIRACLES MIDWIFERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM
Authorized Official - Phone:719-306-2140
Mailing Address - Street 1:PO BOX 7875
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80933-7875
Mailing Address - Country:US
Mailing Address - Phone:719-306-2140
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR STE 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3459
Practice Address - Country:US
Practice Address - Phone:719-306-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty