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General NPI Number Information
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NPI Number | 1851469761
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Entity Type | Organization
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Legal Business Name | LOVELACE HEALTH PLAN
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4101 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3988
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Country | US
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Telephone | 505-263-7363
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Fax | 505-262-3010
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Provider Business Mailing Address
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Address Line | 4101 INDIAN SCHOOL RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3988
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Country | US
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Telephone | 505-263-7363
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Fax | 505-262-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GAYLE Q. ADAMS
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Credential |
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Telephone | 505-262-3831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 1673
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License Number State | NM
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