Healthcare Provider Details

I. General information

NPI: 1023325842
Provider Name (Legal Business Name): LOVELACE HEALTH SYSTEM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 HOSPITAL DR SUITE 202
SANTA FE NM
87505-4754
US

IV. Provider business mailing address

1692 HOSPITAL DR SUITE 202
SANTA FE NM
87505-4754
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-6399
  • Fax: 505-727-9404
Mailing address:
  • Phone: 505-982-6399
  • Fax: 505-727-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberAPPLIED FOR
License Number StateNM

VIII. Authorized Official

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