Healthcare Provider Details

I. General information

NPI: 1598899874
Provider Name (Legal Business Name): NOR-LEA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NORTH MAIN
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-0318
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number3102
License Number StateNM

VIII. Authorized Official

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