Healthcare Provider Details

I. General information

NPI: 1306238183
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W COUNTRY CLUB RD SUITE 1
ROSWELL NM
88201-5839
US

IV. Provider business mailing address

1 BURTON HILLS BLVD SUITE 250
NASHVILLE TN
37215-6293
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-2836
  • Fax: 575-623-2841
Mailing address:
  • Phone: 615-296-3000
  • Fax: 615-296-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C PETROVICH
Title or Position: SVP
Credential:
Phone: 615-296-3000