1164468039 NPI number — FAMILY FIRST HEALTHCARE OF LUBBOCK, LLC

Table of content: MR. TONY BERNARD JOHNSON SR. (NPI 1841750163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164468039 NPI number — FAMILY FIRST HEALTHCARE OF LUBBOCK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTHCARE OF LUBBOCK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164468039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5935 82ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79424-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-794-3000
Provider Business Mailing Address Fax Number:
806-698-0702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5935 82ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424-3673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-794-3000
Provider Business Practice Location Address Fax Number:
806-698-0702
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROZEAN
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
KYLE
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
806-794-3000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  H1314 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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