Provider Demographics
NPI:1376656207
Name:SOUTH PLAINS RURAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTH PLAINS RURAL HEALTH SERVICES, INC.
Other - Org Name:LAMESA PRIMARY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MADURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-894-7842
Mailing Address - Street 1:1000 FM 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-894-7842
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:1502 N AVENUE K
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-3040
Practice Address - Country:US
Practice Address - Phone:806-872-3069
Practice Address - Fax:806-872-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019035701Medicaid
TX019049801Medicaid
TX00F17EMedicare PIN
TX019035701Medicaid