# LUTHERAN HOSPITAL ASSOCIATION OF THE SAN LUIS VALLEY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SLV Regional Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063690600
- **Authorized official:** RUSSELL W. JOHNSON C.E.O. (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (719) 589-2511

## Contact information

- **Practice address:** 19021 HIGHWAY 285, LA JARA, CO 81140
- **Practice address phone:** (719) 274-6000
- **Practice address fax:** (719) 587-1372
- **Mailing address:** 106 BLANCA AVE, ALAMOSA, CO 81101-2340
- **Mailing address phone:** (719) 589-3000
- **Mailing address fax:** (719) 587-1372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/06/2008
- **Last updated:** 02/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 68085770 | — | CO |