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General NPI Number Information
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NPI Number | 1104490556
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Entity Type | Organization
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Legal Business Name | TTUHSC MANAGED CARE
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 1215 AVENUE J
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City | LUBBOCK
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State | TX
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Zip | 79401-4038
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Country | US
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Telephone | 806-743-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 AVENUE J
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City | LUBBOCK
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State | TX
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Zip | 79401-4038
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Country | US
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Telephone | 806-743-3818
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE EXECUTIVE DIRECTOR
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Name | MR. WILL RODRIGUEZ
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Credential |
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Telephone | 806-743-3280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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