Healthcare Provider Details

I. General information

NPI: 1992171433
Provider Name (Legal Business Name): NOR-LEA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 N DAL PASO ST SUITE A
HOBBS NM
88240-3023
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-433-3000
  • Fax: 575-396-4451
Mailing address:
  • Phone: 575-396-9059
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number1T3543
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number4T3543
License Number StateNM

VIII. Authorized Official

Name: DAVID B SHAW
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 575-396-6611