Healthcare Provider Details

I. General information

NPI: 1619305455
Provider Name (Legal Business Name): THE LUBBOCK EMERGENCY ROOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MILWAUKEE AVENUE
LUBBOCK TX
79424
US

IV. Provider business mailing address

7905 MILWAUKEE AVENUE
LUBBOCK TX
79424
US

V. Phone/Fax

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

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: DR. DANIEL BERMAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 806-283-5740