Healthcare Provider Details

I. General information

NPI: 1801002530
Provider Name (Legal Business Name): SOUTH PLAINS ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 AVENUE R
LUBBOCK TX
79412-1603
US

IV. Provider business mailing address

4008 AVENUE R
LUBBOCK TX
79412-1603
US

V. Phone/Fax

Practice location:
  • Phone: 806-832-4531
  • Fax:
Mailing address:
  • Phone: 806-832-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: LETICIA FLORES
Title or Position: DIRECTOR
Credential:
Phone: 806-832-4531