Healthcare Provider Details

I. General information

NPI: 1902084809
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5019
US

IV. Provider business mailing address

10501 GOLF COURSE RD NW
ALBUQUERQUE NM
87114-5019
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-2000
  • Fax: 505-727-9568
Mailing address:
  • Phone: 505-727-2000
  • Fax: 505-727-9568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN C PETROVICH
Title or Position: SVP
Credential:
Phone: 615-296-3000