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General NPI Number Information
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NPI Number | 1245236132
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Entity Type | Organization
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Legal Business Name | LUBBOCK RADIOLOGY LP
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 3707 21ST ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1219
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Country | US
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Telephone | 806-792-2767
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Fax | 806-791-6709
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Provider Business Mailing Address
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Address Line | PO BOX 2160
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City | LUBBOCK
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State | TX
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Zip | 79408-2160
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Country | US
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Telephone | 806-792-2767
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Fax | 806-791-6709
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Authorized Official
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Title or Position | COO
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Name | MONTY MEDANICH
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Credential |
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Telephone | 806-792-2767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State | TX
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