=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154313773
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF LOVINGTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 12/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 S LOVE ST
-----------------------------------------------------
City | LOVINGTON
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88260-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-396-2359
-----------------------------------------------------
Fax | 575-396-7380
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1269
-----------------------------------------------------
City | LOVINGTON
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88260-1269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-396-2359
-----------------------------------------------------
Fax | 575-396-7380
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | TERRANCE LIZARDO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-396-2359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 314343
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------