Basic Information
| Provider Information | |||||||||
| NPI: | 1376656207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH PLAINS RURAL HEALTH SERVICES, INC. | ||||||||
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| OtherOrganizationName: | LAMESA PRIMARY CARE CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 FARM MARKET ROAD | ||||||||
| Address2: | 300 | ||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793366235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068947842 | ||||||||
| FaxNumber: | 8068943378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1502 N AVENUE K | ||||||||
| Address2: | |||||||||
| City: | LAMESA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793313040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068723069 | ||||||||
| FaxNumber: | 8068722952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | HASKELL | ||||||||
| AuthorizedOfficialFirstName: | TARA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8068947842 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 019049801 | 05 | TX | MEDICAID | 019035701 | 05 | TX | MEDICAID |