MEDICARE: LOVELACE HEALTH PLAN

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	302R00000X	Health Maintenance Organization	1673	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851469761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVELACE HEALTH PLAN

Provider Business Mailing Address
First Line	:	4101 INDIAN SCHOOL RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3988
Country	:	US
Telephone Number	:	505-263-7363
Fax Number	:	505-262-3010

Provider Business Practice Location Address
First Line	:	4101 INDIAN SCHOOL RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3988
Country	:	US
Telephone Number	:	505-263-7363
Fax Number	:	505-262-3010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. GAYLE Q. ADAMS
Credential	:
Telephone Number	:	505-262-3831

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/22/2020

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Directions to “LOVELACE HEALTH PLAN ” Practice Location

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