Healthcare Provider Details

I. General information

NPI: 1093793861
Provider Name (Legal Business Name): LAMB COUNTY MEDICAL CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S SUNSET AVE
LITTLEFIELD TX
79339-4810
US

IV. Provider business mailing address

1600 S SUNSET AVE
LITTLEFIELD TX
79339-4810
US

V. Phone/Fax

Practice location:
  • Phone: 806-385-6424
  • Fax: 806-385-4305
Mailing address:
  • Phone: 806-385-6424
  • Fax: 806-385-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ2066
License Number StateTX

VIII. Authorized Official

Name: TONY G HEDGES
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 806-385-6424