Provider Demographics
NPI:1902842404
Name:CSK MEDICAL PARTNERS
Entity Type:Organization
Organization Name:CSK MEDICAL PARTNERS
Other - Org Name:LUBBOCK SPORTS MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-792-4329
Mailing Address - Street 1:4110 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1122
Mailing Address - Country:US
Mailing Address - Phone:806-792-4329
Mailing Address - Fax:806-792-9466
Practice Address - Street 1:4110 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1122
Practice Address - Country:US
Practice Address - Phone:806-792-4329
Practice Address - Fax:806-792-9466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0472270001OtherDMERC
0080EHOtherBLUE CROSS/BLUE SHIELD OF TEXAS
TX00K865Medicare PIN
00JY32Medicare Oscar/Certification
0080EHOtherBLUE CROSS/BLUE SHIELD OF TEXAS
0062BUMedicare Oscar/Certification
0472270001OtherDMERC
00K865Medicare Oscar/Certification
00657YMedicare PIN
TX00657YMedicare PIN
TX0472270001Medicare NSC