Provider Demographics
NPI:1437329182
Name:NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.
Entity Type:Organization
Organization Name:NEW MEXICO PRIMARY CARE & MIDWIFERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVETT
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP, CNM
Authorized Official - Phone:505-286-3100
Mailing Address - Street 1:PO BOX 2729
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-2729
Mailing Address - Country:US
Mailing Address - Phone:505-286-3100
Mailing Address - Fax:505-286-3102
Practice Address - Street 1:1841 HWY 66
Practice Address - Street 2:SUITE B
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9104
Practice Address - Country:US
Practice Address - Phone:505-286-3100
Practice Address - Fax:505-286-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR25968363LF0000X
NM462367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG0889Medicaid
NM000G0919Medicaid
NM00NM006227OtherBCBS
NM201032100OtherPRESBYTERIAN
NM68638OtherPRESBYTERIAN
NMG0889Medicaid
NM585333438PMedicare PIN