| Chcl Dental Mobile Unit | |
|
1610 5th St Lubbock TX 79401-2622 | |
| (806) 765-2611 | |
| (806) 319-9063 |
| Full Name | Chcl Dental Mobile Unit |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1610 5th St, Lubbock, Texas |
| Authorized Official Name and Position | Michael Sullivan (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8067652611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chcl Dental Mobile Unit 1610 5th St Lubbock TX 79401-2622 Ph: (806) 765-2611 | Chcl Dental Mobile Unit 1610 5th St Lubbock TX 79401-2622 Ph: (806) 765-2611 |
| NPI Number | 1720247125 |
|---|---|
| Provider Enumeration Date | 06/02/2008 |
| Last Update Date | 02/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720247125 | NPI | - | NPPES |
| 192462303 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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