Provider Demographics
NPI:1255511325
Name:CIRCLE OF THE SOLITARY
Entity type:Organization
Organization Name:CIRCLE OF THE SOLITARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MIM, MAAC, CIA, EA
Authorized Official - Phone:915-562-9223
Mailing Address - Street 1:1210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1102
Mailing Address - Country:US
Mailing Address - Phone:575-541-6177
Mailing Address - Fax:505-541-6187
Practice Address - Street 1:1210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1102
Practice Address - Country:US
Practice Address - Phone:575-541-6177
Practice Address - Fax:505-541-6187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96320 R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty