Provider Demographics
NPI:1275952608
Name:HIGH DESERT MIDWIFERY LLC
Entity Type:Organization
Organization Name:HIGH DESERT MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:505-450-2222
Mailing Address - Street 1:4916 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3949
Mailing Address - Country:US
Mailing Address - Phone:505-450-2222
Mailing Address - Fax:877-500-7949
Practice Address - Street 1:4916 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3949
Practice Address - Country:US
Practice Address - Phone:505-450-2222
Practice Address - Fax:877-500-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1412R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM54937582Medicaid