1114991718 NPI number — LUBBOCK COUNTY HOSPITAL DISTRICT

Table of content: (NPI 1114991718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114991718 NPI number — LUBBOCK COUNTY HOSPITAL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUBBOCK COUNTY HOSPITAL DISTRICT
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:
6
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:
1114991718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 50TH ST
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79412-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-747-5377
Provider Business Mailing Address Fax Number:
806-747-5465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79412-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-747-5377
Provider Business Practice Location Address Fax Number:
806-747-5465
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
806-747-5377

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  014666 , 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)

  • Identifier: 095149302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146846100 . This is a "FIRST CARE TEAM CHOICE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH027H . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 531587 . This is a "BCBS DME PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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