Healthcare Provider Details

I. General information

NPI: 1821240201
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 THE 25 WAY NE STE. 100
ALBUQUERQUE NM
87109-5857
US

IV. Provider business mailing address

4411 THE 25 WAY NE STE. 100
ALBUQUERQUE NM
87109-5857
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-4265
  • Fax: 505-366-9888
Mailing address:
  • Phone: 505-727-4265
  • Fax: 505-366-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3141
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3140
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3139
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3139
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3141
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3139
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3138
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number3141
License Number StateNM
# 9
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number3141
License Number StateNM

VIII. Authorized Official

Name: MR. RON STERN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 505-727-5204