=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710797949
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHSTAR ANESTHESIA OF NEW MEXICO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 N LOVINGTON HWY
-----------------------------------------------------
City | HOBBS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88240-9109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-492-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6225 N STATE HIGHWAY 161 STE 200
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75038-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-687-0001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSHUA L LUMBLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 617-935-5799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------