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1700871993

NPI Code Detail

MEDICARE: LCT INC

MEDICARE: LCT INC

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	367500000X	Certified Registered Nurse Anesthetist		NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	430074229	OTHER	NM	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM006426	OTHER	NM	BCBS NM GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	NM026426	OTHER	NM	NM BCBS

General Provider Information

NPI Number	:	1700871993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCT INC

Provider Business Mailing Address
First Line	:	62002 NBU20
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2711
Country	:	US
Telephone Number	:	505-747-8639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 SPRUCE ST
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-3456
Country	:	US
Telephone Number	:	505-753-7111
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LORI CARMEN
Credential	:	CRNA
Telephone Number	:	505-747-8639

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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Directions to “LCT INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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