Provider Demographics
NPI:1912035502
Name:LUBBOCK SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:LUBBOCK SURGICAL ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GODINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-2222
Mailing Address - Street 1:3611 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1317
Mailing Address - Country:US
Mailing Address - Phone:806-771-2222
Mailing Address - Fax:806-771-2224
Practice Address - Street 1:3611 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1317
Practice Address - Country:US
Practice Address - Phone:806-771-2222
Practice Address - Fax:806-771-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0034EROtherBCBS GROUP #
TX142446701Medicaid
TX0034EROtherBCBS GROUP #
TX142446701Medicaid