1184957391 NPI number — LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO

Table of content: (NPI 1184957391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184957391 NPI number — LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO
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:
S.E.D. MEDICAL LABORATORIES-FARMINGTON
Provider Other Organization Name Type Code:
5
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:
1184957391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 W ANIMAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-327-3637
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 W ANIMAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-327-3637
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR QUALITY ASSURANCE
Authorized Official Telephone Number:
505-727-6209

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  32D1104327 , 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: 32D1104327 . This is a "CLIA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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