1225289499 NPI number — LUBBOCK HERITAGE HOSPITAL, LLC.

Table of content: (NPI 1225289499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225289499 NPI number — LUBBOCK HERITAGE HOSPITAL, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUBBOCK HERITAGE HOSPITAL, 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:
GRACE SURGICAL HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1225289499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 676200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-725-4000
Provider Business Mailing Address Fax Number:
806-725-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7509 MARSHA SHARP FWY
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:
79407-8202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-725-4000
Provider Business Practice Location Address Fax Number:
806-788-4278
Provider Enumeration Date:
10/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
W
Authorized Official Title or Position:
ASSISTANT SECRETARY OF ENROLLMENTS
Authorized Official Telephone Number:
425-525-5392

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  13005 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: R32837 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0206X , with the licence number: #M01038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 008366 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 008730 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: TX008366 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 45D1057650 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 281514402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2815144 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281514401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".