Healthcare Provider Details

I. General information

NPI: 1912035502
Provider Name (Legal Business Name): LUBBOCK SURGICAL ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 22ND PL
LUBBOCK TX
79410-1317
US

IV. Provider business mailing address

3611 22ND PL
LUBBOCK TX
79410-1317
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-2222
  • Fax: 806-771-2224
Mailing address:
  • Phone: 806-771-2222
  • Fax: 806-771-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH G GODINEZ
Title or Position: BILLING MANAGER
Credential:
Phone: 806-771-2222