Healthcare Provider Details

I. General information

NPI: 1508913948
Provider Name (Legal Business Name): SOUTHWESTERN CARDIOVASCULAR SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 6TH ST
LUBBOCK TX
79416-4732
US

IV. Provider business mailing address

4408 6TH ST
LUBBOCK TX
79416-4732
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-8185
  • Fax: 806-792-9180
Mailing address:
  • Phone: 806-792-8185
  • Fax: 806-792-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT SMITH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 806-792-8185