| Lubbock Cooper Health Center | |
|
12115 Indiana Ave Lubbock TX 79423-5501 | |
| (806) 531-3977 | |
| (806) 531-3978 |
| Full Name | Lubbock Cooper Health Center |
|---|---|
| Speciality | Family Medicine |
| Location | 12115 Indiana Ave, Lubbock, Texas |
| Authorized Official Name and Position | Marcus M Edge (GENERAL MANAGER) |
| Authorized Official Contact | 8066863065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lubbock Cooper Health Center 12115 Indiana Ave Lubbock TX 79423-5501 Ph: (806) 531-3977 | Lubbock Cooper Health Center 12115 Indiana Ave Lubbock TX 79423-5501 Ph: (806) 531-3977 |
| NPI Number | 1831579382 |
|---|---|
| Provider Enumeration Date | 05/30/2015 |
| Last Update Date | 09/23/2024 |
| Medicare PECOS PAC ID | 5991006140 |
|---|---|
| Medicare Enrollment ID | O20151214001337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831579382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | David R Long |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114946480 PECOS PAC ID: 8729049309 Enrollment ID: I20041026001146 |
| Provider Name | Stephanie Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588328280 PECOS PAC ID: 4688065287 Enrollment ID: I20211215000641 |
| Provider Name | Wesley D Otto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811537483 PECOS PAC ID: 0749652287 Enrollment ID: I20230210000557 |
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