Provider Demographics
NPI:1144422148
Name:NORTHERN NEW MEXICO BIRTH CENTER
Entity Type:Organization
Organization Name:NORTHERN NEW MEXICO BIRTH CENTER
Other - Org Name:NORTHERN NEW MEXICO MIDWIFERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:LM CPM
Authorized Official - Phone:575-758-1216
Mailing Address - Street 1:1331 MAESTAS RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:575-758-1216
Mailing Address - Fax:575-758-2683
Practice Address - Street 1:1331 MAESTAS RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:575-758-1216
Practice Address - Fax:575-758-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
NM00405R176B00000X
NM95297R176B00000X
NM07038R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51268Medicaid
NM6552OtherBCBS
NM0051268Medicaid
NM=========OtherMOLINA