=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114789211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUB CITY SURGERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2024
-----------------------------------------------------
Last Update Date | 01/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2232 INDIANA AVE STE 1
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79410-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-395-4705
-----------------------------------------------------
Fax | 806-375-5168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2232 INDIANA AVE STE 1
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79410-2147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-395-4707
-----------------------------------------------------
Fax | 806-375-5168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | RUBEN VILLA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-790-1165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------