Provider Demographics
NPI:1619391422
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER SON LUBBOCK
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER SON LUBBOCK
Other - Org Name:COMBEST SUNRISE CANYON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-743-9355
Mailing Address - Street 1:301 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2746
Mailing Address - Country:US
Mailing Address - Phone:806-743-9355
Mailing Address - Fax:806-743-9363
Practice Address - Street 1:1950 ASPEN AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-1211
Practice Address - Country:US
Practice Address - Phone:806-740-1400
Practice Address - Fax:806-743-9363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER SON LUBBOCK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2071191OtherCLIA