Provider Demographics
NPI:1164468039
Name:FAMILY FIRST HEALTHCARE OF LUBBOCK, LLC
Entity Type:Organization
Organization Name:FAMILY FIRST HEALTHCARE OF LUBBOCK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:ROZEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-794-3000
Mailing Address - Street 1:5935 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3673
Mailing Address - Country:US
Mailing Address - Phone:806-794-3000
Mailing Address - Fax:806-698-0702
Practice Address - Street 1:5935 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3673
Practice Address - Country:US
Practice Address - Phone:806-794-3000
Practice Address - Fax:806-698-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21381Medicare UPIN