Provider Demographics
NPI:1508140740
Name:AFFORDABLE HEALTHCARE CLINIC OF LUBBOCK, INC.
Entity Type:Organization
Organization Name:AFFORDABLE HEALTHCARE CLINIC OF LUBBOCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-533-3924
Mailing Address - Street 1:5815 76TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1721
Mailing Address - Country:US
Mailing Address - Phone:562-533-3924
Mailing Address - Fax:
Practice Address - Street 1:1915 44TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-1727
Practice Address - Country:US
Practice Address - Phone:562-533-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801395284251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable