NPI Number: 1215983788
Health Care Provider/Practitioner: THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION
Information about “1215983788” NPI (THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION)
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<?xml version="1.0" encoding="UTF-8"?>
<Npi>
<NPI>
1215983788
</NPI>
<EntityType>
Organization
</EntityType>
<ReplacementNPI/>
<EIN/>
<IsSoleProprietor/>
<IsOrgSubpart>
N
</IsOrgSubpart>
<ParentOrgLBN/>
<ParentOrgTIN/>
<OrgName>
THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION
</OrgName>
<LastName/>
<FirstName/>
<MiddleName/>
<NamePrefix/>
<NameSuffix/>
<Credential/>
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<OtherLastName/>
<OtherFirstName/>
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<OtherLastNameTypeCode/>
<FirstLineMailingAddress>
3621 22ND ST
</FirstLineMailingAddress>
<SecondLineMailingAddress>
STE 300
</SecondLineMailingAddress>
<MailingAddressCityName>
LUBBOCK
</MailingAddressCityName>
<MailingAddressStateName>
TX
</MailingAddressStateName>
<MailingAddressPostalCode>
79410-1301
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
806-792-5331
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber>
806-792-9417
</MailingAddressFaxNumber>
<FirstLinePracticeLocationAddress>
3621 22ND ST
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress>
STE 300
</SecondLinePracticeLocationAddress>
<PracticeLocationAddressCityName>
LUBBOCK
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
TX
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
79410-1301
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
806-792-5331
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber>
806-792-9417
</PracticeLocationAddressFaxNumber>
<EnumerationDate>
05/26/2006
</EnumerationDate>
<LastUpdateDate>
10/30/2014
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode/>
<Gender/>
<AuthorizedOfficialLastName>
POTOCKI
</AuthorizedOfficialLastName>
<AuthorizedOfficialFirstName>
STAN
</AuthorizedOfficialFirstName>
<AuthorizedOfficialMiddleName>
E
</AuthorizedOfficialMiddleName>
<AuthorizedOfficialTitle>
OWNER
</AuthorizedOfficialTitle>
<AuthorizedOfficialNamePrefix/>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential>
M.D.
</AuthorizedOfficialCredential>
<AuthorizedOfficialTelephoneNumber>
806-792-5331
</AuthorizedOfficialTelephoneNumber>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
207Y00000X
</TaxonomyCode>
<TaxonomyName>
Otolaryngology Physician
</TaxonomyName>
<LicenseNumber/>
<LicenseNumberStateCode/>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups>
<HealthcareProviderTaxonomyGroup>
<HealthcareProviderTaxonomyGroupName>
193400000X SINGLE SPECIALTY GROUP
</HealthcareProviderTaxonomyGroupName>
<HealthcareProviderTaxonomyGroupDescription>
Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
</HealthcareProviderTaxonomyGroupDescription>
</HealthcareProviderTaxonomyGroup>
</HealthcareProviderTaxonomyGroups>
</Npi>
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