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General NPI Number Information
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NPI Number | 1689886319
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Entity Type | Organization
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Legal Business Name | CITY OF LUBBOCK HEALTH DEPARTMENT
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 1902 TEXAS AVE
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City | LUBBOCK
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State | TX
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Zip | 79411
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Country | US
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Telephone | 806-775-2906
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Fax | 806-775-3178
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Provider Business Mailing Address
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Address Line | 1902 TEXAS AVE
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City | LUBBOCK
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State | TX
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Zip | 79411
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Country | US
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Telephone | 806-775-2906
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Fax | 806-775-3178
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CLOYCE STETSON
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Credential | M.D.
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Telephone | 806-743-2463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLIA 45D0660644
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License Number State | TX
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