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General NPI Number Information
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NPI Number | 1003264425
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Entity Type | Organization
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Legal Business Name | LUBBOCK PLASTIC SURGERY CENTER, LP
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 10105 QUAKER AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-7380
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Country | US
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Telephone | 806-797-6398
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Fax | 806-797-6399
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Provider Business Mailing Address
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Address Line | 10105 QUAKER AVE
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City | LUBBOCK
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State | TX
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Zip | 79424-7380
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Country | US
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Telephone | 806-797-6398
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Fax | 806-797-6399
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHAD RICKY SOUTHARD
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Credential | FACHE, FHFMA
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Telephone | 806-797-6398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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