Provider Demographics
NPI:1972878361
Name:LOVELACE HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:LOVELACE HEALTH SYSTEM LLC
Other - Org Name:LOVELACE REGIONAL HOSPITAL-ROSWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP
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 1:117 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5151
Mailing Address - Country:US
Mailing Address - Phone:575-625-3308
Mailing Address - Fax:575-627-7007
Practice Address - Street 1:117 E 19TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5151
Practice Address - Country:US
Practice Address - Phone:575-625-3308
Practice Address - Fax:575-627-7007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARDENT LEGACY HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-19
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1T 352282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07707576Medicaid
NM320086Medicare UPIN
NM07707576Medicaid