Healthcare Provider Details

I. General information

NPI: 1952580433
Provider Name (Legal Business Name): UMC PHYSICIAN NETWORK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 82ND ST
LUBBOCK TX
79423-1900
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3544
US

V. Phone/Fax

Practice location:
  • Phone: 806-722-3150
  • Fax: 806-722-4674
Mailing address:
  • Phone: 806-761-0334
  • Fax: 806-722-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNETT AZZINARO
Title or Position: MANAGER, CENTRAL BUSINESS OPERATION
Credential:
Phone: 806-761-0334