Healthcare Provider Details

I. General information

NPI: 1770666588
Provider Name (Legal Business Name): NOR-LEA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WEST TAYLOR
LOVINGTON NM
88260
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2830
US

V. Phone/Fax

Practice location:
  • Phone: 575-739-0062
  • Fax: 575-739-0064
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number66326
License Number StateNM

VIII. Authorized Official

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