Basic Information
| Provider Information | |||||||||
| NPI: | 1245798024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVELACE HEALTH SYSTEM LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BURTON HILLS BLVD STE 250 | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372156195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152963000 | ||||||||
| FaxNumber: | 6152966227 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 SAINT MICHAELS DR STE 505 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057274420 | ||||||||
| FaxNumber: | 5057279420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 03/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | PETROVICH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6152963000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.