1073791125 NPI number — LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY

Table of content: (NPI 1073791125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073791125 NPI number — LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLV REGIONAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073791125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 BLANCA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOSA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81101-2340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-589-3000
Provider Business Mailing Address Fax Number:
719-587-1372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1280 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL NORTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81132-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-657-2418
Provider Business Practice Location Address Fax Number:
719-587-1372
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
719-589-2511

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 68085770 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com