Provider Demographics
NPI:1275317646
Name:EXCEPTIONAL PHYSICIANS GROUP LUBBOCK HOSPITAL PLLC
Entity Type:Organization
Organization Name:EXCEPTIONAL PHYSICIANS GROUP LUBBOCK HOSPITAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SYSTEM ADVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-740-9335
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:469-341-7887
Practice Address - Street 1:6401 SPUR 327
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2719
Practice Address - Country:US
Practice Address - Phone:806-630-4501
Practice Address - Fax:469-341-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty