Provider Demographics
NPI:1609273283
Name:LOVELACE HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:LOVELACE HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3000
Mailing Address - Street 1:1 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6293
Mailing Address - Country:US
Mailing Address - Phone:615-296-3000
Mailing Address - Fax:615-296-6011
Practice Address - Street 1:1112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5010
Practice Address - Country:US
Practice Address - Phone:575-627-4200
Practice Address - Fax:575-627-4212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARDENT LEGACY HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-26
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
320086Medicare Oscar/Certification