1992757710 NPI number — AHS LOVELACE MEDICAL GROUP, LLC

Table of content: (NPI 1992757710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992757710 NPI number — AHS LOVELACE MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHS LOVELACE MEDICAL GROUP, LLC
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:
Provider Other Organization Name Type Code:
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:
1992757710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BURTON HILLS BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-296-3000
Provider Business Mailing Address Fax Number:
615-296-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 GIBSON BLVD SE
Provider Second Line Business Practice Location Address:
FLOOR 2, ELEVATOR B
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87108-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-262-7174
Provider Business Practice Location Address Fax Number:
505-262-3562
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETROVICH
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SVP
Authorized Official Telephone Number:
615-296-3000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  APPLIED FOR , 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)





Copyright © 2007-2025 www.npivalidator.com