Provider Demographics
NPI:1093793861
Name:LAMB COUNTY MEDICAL CLINIC LLP
Entity Type:Organization
Organization Name:LAMB COUNTY MEDICAL CLINIC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-385-6424
Mailing Address - Street 1:1600 S SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-4810
Mailing Address - Country:US
Mailing Address - Phone:806-385-6424
Mailing Address - Fax:806-385-4305
Practice Address - Street 1:1600 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4810
Practice Address - Country:US
Practice Address - Phone:806-385-6424
Practice Address - Fax:806-385-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084272601Medicaid
TXCG5760OtherMEDICARE RAILROAD GROUP
TX114852125OtherFIRSTCARE
TX85W781OtherBCBS IND
TX00N67TOtherBCBS GROUP
TX136411902Medicaid
TX080060101OtherMEDICARE RAILROAD
TX00N67TOtherBCBS GROUP
TX85W781OtherBCBS IND
TX00N67TMedicare PIN