Provider Demographics
NPI:1609995158
Name:LUBBOCK DIGESTIVE DISEASE ASSOCIATES
Entity Type:Organization
Organization Name:LUBBOCK DIGESTIVE DISEASE ASSOCIATES
Other - Org Name:DIGESTIVE DISEASE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-793-3141
Mailing Address - Street 1:3610 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2014
Mailing Address - Country:US
Mailing Address - Phone:806-793-3141
Mailing Address - Fax:
Practice Address - Street 1:3610 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2014
Practice Address - Country:US
Practice Address - Phone:806-793-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DG49Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER