Healthcare Provider Details

I. General information

NPI: 1285187237
Provider Name (Legal Business Name): WTER QUAKER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10205 QUAKER AVE
LUBBOCK TX
79424
US

IV. Provider business mailing address

7905 MILWAUKEE AVE
LUBBOCK TX
79424-0616
US

V. Phone/Fax

Practice location:
  • Phone: 806-368-5837
  • Fax: 806-368-5852
Mailing address:
  • Phone: 806-368-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARLA EMORY
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 806-368-8606