Provider Demographics
NPI:1225357981
Name:LOVELACE HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:LOVELACE HEALTH SYSTEM, INC.
Other - Org Name:ISLETA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-727-0019
Mailing Address - Street 1:11000 BROADWAY BLVD SE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7469
Mailing Address - Country:US
Mailing Address - Phone:505-244-8116
Mailing Address - Fax:
Practice Address - Street 1:11000 BROADWAY BLVD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-7469
Practice Address - Country:US
Practice Address - Phone:505-244-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARDENT HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care