Provider Demographics
NPI:1700871993
Name:LCT INC
Entity Type:Organization
Organization Name:LCT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:505-747-8639
Mailing Address - Street 1:62002 NBU20
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2711
Mailing Address - Country:US
Mailing Address - Phone:505-747-8639
Mailing Address - Fax:
Practice Address - Street 1:1010 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3456
Practice Address - Country:US
Practice Address - Phone:505-753-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006426OtherBCBS NM GROUP
NM17104505Medicaid
NM430074229OtherRAILROAD MEDICARE
NMNM026426OtherNM BCBS
NM17104505Medicaid
NM430074229OtherRAILROAD MEDICARE