Healthcare Provider Details

I. General information

NPI: 1023274172
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 BROADWAY
LUBBOCK TX
79401-3206
US

IV. Provider business mailing address

1313 BROADWAY SUITE 5
LUBBOCK TX
79401-3277
US

V. Phone/Fax

Practice location:
  • Phone: 806-765-2611
  • Fax: 806-767-0589
Mailing address:
  • Phone: 806-765-2605
  • Fax: 806-765-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH GOOLSBY
Title or Position: HUMAN RESOURCES DIRECTOR
Credential:
Phone: 806-765-2605