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General NPI Number Information
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NPI Number | 1316213606
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Entity Type | Organization
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Legal Business Name | LOVELACE HEALTH SYSTEM INC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 2335 N MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88201-6452
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Country | US
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Telephone | 575-622-4665
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Fax | 575-622-4557
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Provider Business Mailing Address
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Address Line | 2335 N MAIN ST
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City | ROSWELL
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State | NM
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Zip | 88201-6452
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Country | US
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Telephone | 575-622-4665
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Fax | 575-622-4557
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Authorized Official
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Title or Position | SVP
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Name | STEPHEN C PETROVICH
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Credential |
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Telephone | 615-296-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NM
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