1992708705 NPI number — LUBBOCK REGIONAL MHMR CENTER

Table of content: (NPI 1992708705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992708705 NPI number — LUBBOCK REGIONAL MHMR CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUBBOCK REGIONAL MHMR CENTER
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:
STARCARE SPECIALTY HEALTH SYSTEM
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:
1992708705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2828
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:
79408-2828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-766-0310
Provider Business Mailing Address Fax Number:
806-766-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 22ND 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:
79410-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-740-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MONTALVO
Authorized Official First Name:
GRACIE
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT SUPERVISOR
Authorized Official Telephone Number:
806-766-0273

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001018313 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-07 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-08 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1D9349 . This is a "MEDICARE B OTP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0848970-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-09 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1364929-11 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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