Provider Demographics
NPI:1073524666
Name:SOUTHWEST HEMATOLOGY-ONCOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:SOUTHWEST HEMATOLOGY-ONCOLOGY ASSOCIATES PA
Other - Org Name:SOUTHWEST HEMATOLOGY ONCOLOGY ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:BRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-793-6654
Mailing Address - Street 1:4002 21ST ST
Mailing Address - Street 2:STE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1135
Mailing Address - Country:US
Mailing Address - Phone:806-793-8310
Mailing Address - Fax:806-793-7871
Practice Address - Street 1:4002 21ST ST
Practice Address - Street 2:STE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1135
Practice Address - Country:US
Practice Address - Phone:806-793-8310
Practice Address - Fax:806-793-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 3336S0011X
TX156663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093517OtherPK
TX0081556501Medicaid
TX0081556501Medicaid