Provider Demographics
NPI:1154313773
Name:CITY OF LOVINGTON
Entity Type:Organization
Organization Name:CITY OF LOVINGTON
Other - Org Name:LOVINGTON AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-396-2359
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-1269
Mailing Address - Country:US
Mailing Address - Phone:575-396-2359
Mailing Address - Fax:575-396-7380
Practice Address - Street 1:213 S LOVE ST
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-4238
Practice Address - Country:US
Practice Address - Phone:575-396-2359
Practice Address - Fax:575-396-7380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF LOVINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-19
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM314343341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR042OtherBSBC
NMR0571Medicaid
NMR042OtherBSBC