MEDICARE: LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	32D1104327	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32D1104327	OTHER	NM	CLIA

General Provider Information

NPI Number	:	1184957391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO

Provider Business Mailing Address
First Line	:	727 W ANIMAS ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5616
Country	:	US
Telephone Number	:	505-327-3637
Fax Number	:

Provider Business Practice Location Address
First Line	:	724 W ANIMAS ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5617
Country	:	US
Telephone Number	:	505-327-3637
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR QUALITY ASSURANCE
Name	:	MRS. SUSAN MARTIN
Credential	:
Telephone Number	:	505-727-6209

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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