Provider Demographics
NPI:1063468031
Name:LUBBOCK COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:LUBBOCK COUNTY HOSPITAL DISTRICT
Other - Org Name:UMC RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDERBURK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-775-8400
Mailing Address - Street 1:PO BOX 5980
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5980
Mailing Address - Country:US
Mailing Address - Phone:806-761-0878
Mailing Address - Fax:806-472-6802
Practice Address - Street 1:602 INDIANA AVENUE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-775-8400
Practice Address - Fax:806-775-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156506101Medicaid
NM55552021Medicaid
NM55552021Medicaid
TX00422UMedicare PIN