Provider Demographics
NPI:1164780128
Name:HUMMINGBIRD MIDWIFERY LLC
Entity Type:Organization
Organization Name:HUMMINGBIRD MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIE
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:505-262-1690
Mailing Address - Street 1:413 PACIFIC AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4166
Mailing Address - Country:US
Mailing Address - Phone:505-262-1690
Mailing Address - Fax:
Practice Address - Street 1:413 PACIFIC AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4166
Practice Address - Country:US
Practice Address - Phone:505-262-1690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98902351Medicaid
NM50851764Medicaid