1952580433 NPI number — UMC PHYSICIAN NETWORK SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952580433 NPI number — UMC PHYSICIAN NETWORK SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMC PHYSICIAN NETWORK SERVICES
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:
1952580433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5219 CITY BANK PKWY
Provider Second Line Business Mailing Address:
STE 35
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79407-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-761-0334
Provider Business Mailing Address Fax Number:
806-722-2908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4004 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:
79423-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-722-3150
Provider Business Practice Location Address Fax Number:
806-722-4674
Provider Enumeration Date:
10/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AZZINARO
Authorized Official First Name:
JENNETT
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER, CENTRAL BUSINESS OPERATION
Authorized Official Telephone Number:
806-761-0334

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FTX078 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147762201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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