| Enrique Rodriguez, M.d., P.a. | |
|
1902 50th St Lubbock TX 79412-2706 | |
| (806) 771-1386 | |
| (806) 771-1388 |
| Full Name | Enrique Rodriguez, M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1902 50th St, Lubbock, Texas |
| Authorized Official Name and Position | Enrique Rodriguez (PRESIDENT) |
| Authorized Official Contact | 8067711386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Enrique Rodriguez, M.d., P.a. Po Box 54136 Lubbock TX 79453-4136 Ph: (806) 771-1386 | Enrique Rodriguez, M.d., P.a. 1902 50th St Lubbock TX 79412-2706 Ph: (806) 771-1386 |
| NPI Number | 1467482182 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 01/28/2010 |
| Medicare PECOS PAC ID | 4789573502 |
|---|---|
| Medicare Enrollment ID | O20040311000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467482182 | NPI | - | NPPES |
| 163272102 | Medicaid | TX | |
| 0011NR | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | J4998 (Texas) | Primary |
| 363L00000X | Nurse Practitioner | 577500 (Texas) | Secondary |
| Provider Name | Traci Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659301471 PECOS PAC ID: 6709775570 Enrollment ID: I20040311000655 |
| Provider Name | Enrique Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326079021 PECOS PAC ID: 2961399944 Enrollment ID: I20040311001100 |
| Provider Name | Gay A Tibbets |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003097155 PECOS PAC ID: 6901989565 Enrollment ID: I20080206000257 |
| Provider Name | Joe P Dickinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134376213 PECOS PAC ID: 7113088766 Enrollment ID: I20081202000172 |
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