Healthcare Provider Details

I. General information

NPI: 1043594179
Provider Name (Legal Business Name): LUBBOCK CT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 N GRIMES ST
HOBBS NM
88240-1219
US

IV. Provider business mailing address

3305 N GRIMES ST
HOBBS NM
88240-1219
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-0120
  • Fax: 575-738-1521
Mailing address:
  • Phone: 575-392-0120
  • Fax: 575-738-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT S NEIDERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 806-792-6736