Provider Demographics
NPI:1770689622
Name:LOVELACE HEALTHCARE CENTER-JUAN TABO NORTH
Entity Type:Organization
Organization Name:LOVELACE HEALTHCARE CENTER-JUAN TABO NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-262-3085
Mailing Address - Street 1:2121 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3307
Mailing Address - Country:US
Mailing Address - Phone:505-237-8800
Mailing Address - Fax:505-237-8803
Practice Address - Street 1:2121 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-3307
Practice Address - Country:US
Practice Address - Phone:505-237-8800
Practice Address - Fax:505-237-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty