Provider Demographics
NPI:1568819472
Name:SPRINGS MIDWIFERY AND WOMEN'S CARE, LLC
Entity Type:Organization
Organization Name:SPRINGS MIDWIFERY AND WOMEN'S CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM, WHNP-BC
Authorized Official - Phone:719-367-9405
Mailing Address - Street 1:5028 GALLOPING GOOSE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2915
Mailing Address - Country:US
Mailing Address - Phone:719-367-9405
Mailing Address - Fax:719-434-9777
Practice Address - Street 1:5028 GALLOPING GOOSE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2915
Practice Address - Country:US
Practice Address - Phone:719-367-9405
Practice Address - Fax:719-434-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991275-CNM261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73130052Medicaid