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General NPI Number Information
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NPI Number | 1578639647
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF STATE HEALTH SERVICES
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 6302 LOLA
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | US
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Telephone | 806-744-3577
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Fax | 806-783-6475
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Provider Business Mailing Address
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Address Line | 1100 W. 49TH ST.
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City | AUSTIN
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State | TX
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Zip | 78756
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Country | US
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Telephone | 806-458-7111
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Fax |
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Authorized Official
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Title or Position | DEPUTY REGIONAL DIRECTOR
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Name | BARRY WILSON
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Credential |
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Telephone | 806-744-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health 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 | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | H4610
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License Number State | TX
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