Basic Information
| Provider Information | |||||||||
| NPI: | 1023274172 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HEALTH CENTER OF LUBBOCK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 BROADWAY | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794013277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067652605 | ||||||||
| FaxNumber: | 8067652604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1318 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794013206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067652611 | ||||||||
| FaxNumber: | 8067670589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 07/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | GOOLSBY | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8067652605 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.