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General NPI Number Information
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NPI Number | 1255703849
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Entity Type | Organization
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Legal Business Name | WELDON L. ASH
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 3809 22ND STREET
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City | LUBBOCK
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State | TX
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Zip | 79410-1198
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Country | US
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Telephone | 806-319-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 3809 22ND ST SUITE 2C
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City | LUBBOCK
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State | TX
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Zip | 79410-1198
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Country | US
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Telephone | 806-319-2900
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Fax | 806-317-1687
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Authorized Official
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Title or Position | APPROVER
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Name | MARILYN NOBLE
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Credential |
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Telephone | 806-319-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06036
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License Number State | TX
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