Healthcare Provider Details

I. General information

NPI: 1275715831
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

4101 INDIAN SCHOOL RD NE SUITE 405
ALBUQUERQUE NM
87110-3988
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-5220
  • Fax: 505-727-5225
Mailing address:
  • Phone: 505-727-5220
  • Fax: 505-727-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

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