Healthcare Provider Details

I. General information

NPI: 1861692345
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEMS,INC.DBA S.E.D. MEDICAL LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
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

5601 OFFICE BLVD NE
ALBUQUERQUE NM
87109-5879
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-6425
  • Fax: 505-727-6417
Mailing address:
  • Phone: 505-727-6210
  • Fax: 505-727-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. SCHELLEY JO CARLTON
Title or Position: BILLING MANAGER
Credential:
Phone: 505-727-6210