Provider Demographics
NPI:1003264425
Name:LUBBOCK PLASTIC SURGERY CENTER, LP
Entity Type:Organization
Organization Name:LUBBOCK PLASTIC SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RICKY
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, FHFMA
Authorized Official - Phone:806-797-6398
Mailing Address - Street 1:10105 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7380
Mailing Address - Country:US
Mailing Address - Phone:806-797-6398
Mailing Address - Fax:806-797-6399
Practice Address - Street 1:10105 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7380
Practice Address - Country:US
Practice Address - Phone:806-797-6398
Practice Address - Fax:806-797-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical