Provider Demographics
NPI:1992171433
Name:NOR-LEA HOSPITAL DISTRICT
Entity type:Organization
Organization Name:NOR-LEA HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-396-6611
Mailing Address - Street 1:1600 NORTH MAIN
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2830
Mailing Address - Country:US
Mailing Address - Phone:575-396-9059
Mailing Address - Fax:575-396-1454
Practice Address - Street 1:1923 N DAL PASO ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3023
Practice Address - Country:US
Practice Address - Phone:575-433-3000
Practice Address - Fax:575-396-4451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOR-LEA HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1T3543261QR1300X
NM4T3543261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32-3404OtherMEDICARE PTAN-RURAL HEALTH CLINIC