Healthcare Provider Details

I. General information

NPI: 1972505147
Provider Name (Legal Business Name): LUBBOCK ARTIFICIAL LIMB & BRACE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 UNIVERSITY AVE
LUBBOCK TX
79423-2125
US

IV. Provider business mailing address

7619 UNIVERSITY AVE
LUBBOCK TX
79423-2125
US

V. Phone/Fax

Practice location:
  • Phone: 806-799-1518
  • Fax: 806-799-5462
Mailing address:
  • Phone: 806-799-1518
  • Fax: 806-799-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHEILA PHILLIPS
Title or Position: PARTNER / CFO
Credential:
Phone: 806-799-1518