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NPI Code Detail

MEDICARE: LUBBOCK CARDIOLOGY SPECIALISTS, PA

MEDICARE: LUBBOCK CARDIOLOGY SPECIALISTS, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215910633
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUBBOCK CARDIOLOGY SPECIALISTS, PA
Provider Business Mailing Address
First Line : 4802 N LOOP 289
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3025
Country : US
Telephone Number : 806-788-0040
Fax Number : 806-784-4202
Provider Business Practice Location Address
First Line : 4802 N LOOP 289
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3025
Country : US
Telephone Number : 806-788-0040
Fax Number : 806-788-0015
Authorized Official
Title or Position : ADMINISTRATOR
Name : MAIA GHANDOUR
Credential :
Telephone Number : 806-788-0040
Provider Enumeration Date : 11/21/2005
Last Update Date : 09/08/2017

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Directions to “LUBBOCK CARDIOLOGY SPECIALISTS, PA ” Practice Location

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