Basic Information
| Provider Information | |||||||||
| NPI: | 1871530428 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEA REGIONAL HOSPITAL LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEA REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848156 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054925000 | ||||||||
| FaxNumber: | 5054925505 | ||||||||
| Practice Location | |||||||||
| Address1: | 5419 N LOVINGTON HWY | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882409100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054925000 | ||||||||
| FaxNumber: | 5054925505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 02/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | LALOR | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR / DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159254565 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEA REGIONAL HOSPITAL LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 6745 | NM | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | B3197 | 05 | NM | MEDICAID |