Healthcare Provider Details

I. General information

NPI: 1851469761
Provider Name (Legal Business Name): LOVELACE HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3988
US

IV. Provider business mailing address

4101 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3988
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-7363
  • Fax: 505-262-3010
Mailing address:
  • Phone: 505-263-7363
  • Fax: 505-262-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1673
License Number StateNM

VIII. Authorized Official

Name: MS. GAYLE Q. ADAMS
Title or Position: PRESIDENT
Credential:
Phone: 505-262-3831