Healthcare Provider Details

I. General information

NPI: 1710797949
Provider Name (Legal Business Name): NORTHSTAR ANESTHESIA OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N LOVINGTON HWY
HOBBS NM
88240-9109
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 575-492-5000
  • Fax:
Mailing address:
  • Phone: 214-687-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L LUMBLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 617-935-5799