Healthcare Provider Details

I. General information

NPI: 1174559082
Provider Name (Legal Business Name): NOR-LEA HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MAIN
TATUM NM
88267-9802
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-398-2111
  • Fax: 575-398-6112
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 Number6260
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number6260
License Number StateNM

VIII. Authorized Official

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