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General NPI Number Information
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NPI Number | 1790167104
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Entity Type | Organization
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Legal Business Name | HCAA MEDICAL GROUP, PA
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/22/2015
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Provider Practice Location Address
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Address Line | 25 BRIERCROFT OFFICE PARK
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City | LUBBOCK
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State | TX
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Zip | 79412-3011
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Country | US
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Telephone | 806-795-7433
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Fax |
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Provider Business Mailing Address
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Address Line | 25 BRIERCROFT OFFICE PARK
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City | LUBBOCK
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State | TX
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Zip | 79412-3011
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Country | US
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Telephone | 806-795-7433
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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 | BRYCE OLSON
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Credential |
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Telephone | 806-795-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G6867
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License Number State | TX
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