MEDICARE: LUBBOCK HEART HOSPITAL, LLC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	008015	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	HH1038	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1922001775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUBBOCK HEART HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	4810 NORTH LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-3025
Country	:	US
Telephone Number	:	806-687-7777
Fax Number	:	806-472-3763

Provider Business Practice Location Address
First Line	:	4810 NORTH LOOP 289
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-3025
Country	:	US
Telephone Number	:	806-687-7777
Fax Number	:	806-472-3763

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROY C. VINSON
Credential	:	FACHE
Telephone Number	:	806-687-7777

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/15/2012

4810 N LOOP 289
LUBBOCK, TX
79416-3025

Practice Phone: 806-687-7777
Practice Fax: 800-305-3233