Provider Demographics
NPI:1922001775
Name:LUBBOCK HEART HOSPITAL, LLC
Entity Type:Organization
Organization Name:LUBBOCK HEART HOSPITAL, LLC
Other - Org Name:LUBBOCK HEART HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:806-687-7777
Mailing Address - Street 1:4810 NORTH LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3025
Mailing Address - Country:US
Mailing Address - Phone:806-687-7777
Mailing Address - Fax:806-472-3763
Practice Address - Street 1:4810 NORTH LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3025
Practice Address - Country:US
Practice Address - Phone:806-687-7777
Practice Address - Fax:806-472-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008015282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163219201Medicaid
NM78174287Medicaid
TXHH1038OtherBCBS
TX163219202Medicaid
TX450876Medicare Oscar/Certification