1528002805 NPI number — NOR-LEA HOSPITAL DISTRICT

Table of content: (NPI 1528002805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528002805 NPI number — NOR-LEA HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOR-LEA HOSPITAL DISTRICT
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:
FAMILY HEALTH CENTER OF LEA COUNTY
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:
1528002805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 NORTH MAIN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88260-2830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-396-9059
Provider Business Mailing Address Fax Number:
575-396-1454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBBS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88240-8119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-397-0560
Provider Business Practice Location Address Fax Number:
575-397-0836
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO/ADMINISTRATION
Authorized Official Telephone Number:
575-396-6611

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  2258209 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 32-3405 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32-3405 . This is a "MEDICARE PTAN-RURAL HEALTH CLINIC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 2258209 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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