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3601 4th St Room 3a105 Lubbock TX 79430-0002 | |
| (806) 743-2391 | |
| (806) 743-5687 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 3601 4th St, Lubbock, Texas |
| Authorized Official Name and Position | Brent Magers (ASSISTANT DEAN OF FINANCE ADMIN) |
| Authorized Official Contact | 8067431830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 27476 Salt Lake City UT 84127-0476 Ph: (806) 743-4263 | 3601 4th St Room 3a105 Lubbock TX 79430-0002 Ph: (806) 743-2391 |
| NPI Number | 1518916808 |
|---|---|
| Provider Enumeration Date | 05/06/2006 |
| Last Update Date | 03/07/2022 |
| Certification Date | 03/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518916808 | NPI | - | NPPES |
| 00QQ88 | Other | TX | BC/BS |
| G1217 | Medicaid | NM | |
| CD9207 | Other | TX | RAILROAD MEDICARE |
| 084593503 | Medicaid | TX | |
| 084593504 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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