Healthcare Provider Details

I. General information

NPI: 1164528972
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM:PULMONARY DISEASE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5090
US

IV. Provider business mailing address

4801 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5090
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3100
  • Fax: 505-727-3131
Mailing address:
  • Phone: 505-727-3100
  • Fax: 505-727-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: HARRY MAGNES
Title or Position: CEO
Credential: MD
Phone: 505-262-3085