Organization
BLOOM AND GROW PEDIATRICS LLC
Active
Other names
Bloom and Grow Pediatrics, Bloom Medical Services LLC, Bloom Medical Services
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BRUCE CPNP (OWNER)
(575) 921-2318
Entity
Organization
Contact information
Practice address
1315 BURRO AVE, CLOUDCROFT, NM 88317-7719
(575) 682-2002
Mailing address
PO BOX 1902, CLOUDCROFT, NM 88317-1902
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326276395
TYPE 1 NPI
NM
05
—
99120330
—
NM
Enumeration date
01/18/2019
Last updated
07/01/2022
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