Provider Demographics
NPI:1336308105
Name:PHYSICIAN NETWORK SERVICES
Entity Type:Organization
Organization Name:PHYSICIAN NETWORK SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-761-0333
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 135
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:5219 CITY BANK PKWY
Practice Address - Street 2:STE 135
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3544
Practice Address - Country:US
Practice Address - Phone:806-761-0333
Practice Address - Fax:806-722-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059AUMedicare PIN