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General NPI Number Information
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NPI Number | 1922280304
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Entity Type | Individual
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Provider Name | JASON GLENN POLK BS, RRT, RCP
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Gender | Male
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 517 82ND ST
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City | LUBBOCK
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State | TX
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Zip | 79404-6337
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Country | US
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Telephone | 806-745-2551
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Fax | 806-745-5171
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Provider Business Mailing Address
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Address Line | 517 82ND ST
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City | LUBBOCK
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State | TX
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Zip | 79404-6337
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Country | US
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Telephone | 806-745-2551
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Fax | 806-745-5171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2279H0200X
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Taxonomy Name | Home Health Registered Respiratory Therapist
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License Number | 57131
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2279H0200X
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Taxonomy Name | Home Health Registered Respiratory Therapist
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License Number | 2464
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License Number State | NM
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