1467532416 NPI number — DR. JASON BRADLEY LENTZ MD

Table of content: DR. JASON BRADLEY LENTZ MD (NPI 1467532416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467532416 NPI number — DR. JASON BRADLEY LENTZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENTZ
Provider First Name:
JASON
Provider Middle Name:
BRADLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1467532416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2021
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 STE 35
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:
79407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-761-0333
Provider Business Mailing Address Fax Number:
806-782-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4105 I-27
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:
79404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-762-2633
Provider Business Practice Location Address Fax Number:
806-761-0431
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  M4282 , 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: 8AK612 . This is a "BCBS CLINIC IND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BB500 . This is a "BCBS CLINIC B IND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Y578 . This is a "BCBS CLINIC B GRP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 162693901 . This is a "LHC MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0095RB . This is a "BCBS CLINIC B GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 170791101 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F7078 . This is a "BCBS CLINIC B IND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 191767601 . This is a "MEDICAID CLINIC B IND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J9094 . This is a "MEDICARE HOSP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 191766801 . This is a "MEDICAID CLINIC B GRP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 191767602 . This is a "HOSP MEDICAID TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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