Healthcare Provider Details

I. General information

NPI: 1144549668
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 THE AMERICAN RD NW
ALBUQUERQUE NM
87114-1338
US

IV. Provider business mailing address

3777 THE AMERICAN RD NW
ALBUQUERQUE NM
87114-1338
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-2185
  • Fax:
Mailing address:
  • Phone: 505-890-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SANDOVAL
Title or Position: DIRECTOR OF CONTRACTING
Credential:
Phone: 505-727-0019