Healthcare Provider Details

I. General information

NPI: 1265767800
Provider Name (Legal Business Name): NOR-LEA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

IV. Provider business mailing address

1600 N MAIN AVE
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-5971
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH000002159
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

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