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General NPI Number Information
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NPI Number | 1508140740
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Entity Type | Organization
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Legal Business Name | AFFORDABLE HEALTHCARE CLINIC OF LUBBOCK, INC.
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Dates
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Enumeration Date | 10/06/2011
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 1915 44TH ST
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City | LUBBOCK
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State | TX
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Zip | 79412-1727
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Country | US
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Telephone | 562-533-3924
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Fax |
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Provider Business Mailing Address
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Address Line | 5815 76TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-1721
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Country | US
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Telephone | 562-533-3924
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN ROBERT SOTO
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Credential |
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Telephone | 562-533-3924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 801395284
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License Number State | TX
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