Healthcare Provider Details

I. General information

NPI: 1386709327
Provider Name (Legal Business Name): SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 50TH ST STE A
LUBBOCK TX
79413-4003
US

IV. Provider business mailing address

PO BOX 610 411 AUSTIN ST
LEVELLAND TX
79336-0610
US

V. Phone/Fax

Practice location:
  • Phone: 806-797-6393
  • Fax: 806-797-6397
Mailing address:
  • Phone: 806-894-6104
  • Fax: 806-897-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. WILLIAM D POWELL JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 806-894-6104