MEDICARE: SOUTH PLAINS RURAL HEALTH SERVICES, INC

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1407116304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PLAINS RURAL HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1000 FM 300
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336-6235
Country	:	US
Telephone Number	:	806-894-7842
Fax Number	:	806-894-3378

Provider Business Practice Location Address
First Line	:	2424 50TH ST
Second Line	:	SUITE 204
City	:	LUBBOCK
State	:	TX
Zip	:	79412-2549
Country	:	US
Telephone Number	:	806-897-1987
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JUDITH M MADURA
Credential	:	M.D.
Telephone Number	:	806-894-7842

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	05/24/2012

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