Healthcare Provider Details

I. General information

NPI: 1639196546
Provider Name (Legal Business Name): SOUTHWEST DIAGNOSTIC CLINIC, L.L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 50TH ST
LUBBOCK TX
79413-3859
US

IV. Provider business mailing address

PO BOX 6248
LUBBOCK TX
79493-6248
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-5550
  • Fax: 806-771-5544
Mailing address:
  • Phone: 806-771-5550
  • Fax: 806-771-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: GLENDA W COCHRAN
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 806-771-5550