Provider Demographics
NPI:1184957391
Name:LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO
Entity type:Organization
Organization Name:LOVELACE HEALTH SYSTEMS INC. DBA S.E.D. MEDICAL LABORATORIES-FARMINGTO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR QUALITY ASSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-727-6209
Mailing Address - Street 1:727 W ANIMAS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5616
Mailing Address - Country:US
Mailing Address - Phone:505-327-3637
Mailing Address - Fax:
Practice Address - Street 1:724 W ANIMAS ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5617
Practice Address - Country:US
Practice Address - Phone:505-327-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM32D1104327291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32D1104327OtherCLIA