Provider Demographics
NPI:1437443538
Name:SOUTH PLAINS PEDIATRIC CARDIOLOGY, P.A.
Entity Type:Organization
Organization Name:SOUTH PLAINS PEDIATRIC CARDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOMKIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPONTAMMARAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-441-1257
Mailing Address - Street 1:4503 82ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4239
Mailing Address - Country:US
Mailing Address - Phone:806-441-1257
Mailing Address - Fax:325-200-4498
Practice Address - Street 1:6401 INDIANA AVE STE C
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5740
Practice Address - Country:US
Practice Address - Phone:806-441-1257
Practice Address - Fax:325-200-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN93042080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty