Healthcare Provider Details

I. General information

NPI: 1588795603
Provider Name (Legal Business Name): BHUPESH HASMUKH DIHENIA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 23RD ST
LUBBOCK TX
79410-1809
US

IV. Provider business mailing address

3815 23RD ST
LUBBOCK TX
79410-1809
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-3500
  • Fax: 806-796-0689
Mailing address:
  • Phone: 806-722-3500
  • Fax: 806-796-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberK3156
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK3156
License Number StateTX

VIII. Authorized Official

Name: DR. BHUPESH H DIHENIA
Title or Position: CEO
Credential: M.D.
Phone: 806-722-3500