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General NPI Number Information
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NPI Number | 1588846612
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Entity Type | Organization
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Legal Business Name | GREAT PLAINS CARE TEAM
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 4515 MARSHA SHARP FWY
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City | LUBBOCK
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State | TX
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Zip | 79407-2520
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Country | US
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Telephone | 806-744-7223
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Fax | 806-740-3325
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Provider Business Mailing Address
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Address Line | 4515 MARSHA SHARP FWY
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City | LUBBOCK
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State | TX
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Zip | 79407-2520
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Country | US
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Telephone | 806-744-7223
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Fax | 806-740-3325
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL S. HICKLE
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Credential | M.D.
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Telephone | 806-744-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | TX
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