Provider Demographics
NPI:1639163231
Name:LUBBOCK GYNECOLOGIC ONCOLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:LUBBOCK GYNECOLOGIC ONCOLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:806-796-1317
Mailing Address - Street 1:3621 22ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1301
Mailing Address - Country:US
Mailing Address - Phone:806-796-1317
Mailing Address - Fax:806-796-0426
Practice Address - Street 1:3621 22ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1301
Practice Address - Country:US
Practice Address - Phone:806-796-1317
Practice Address - Fax:806-796-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00897KOtherBLUE CROSS BLUE SHIELD
TX00897KOtherBLUE CROSS BLUE SHIELD