Provider Demographics
NPI:1922280304
Name:POLK, JASON GLENN (BS, RRT, RCP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:GLENN
Last Name:POLK
Suffix:
Gender:M
Credentials:BS, RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-6337
Mailing Address - Country:US
Mailing Address - Phone:806-745-2551
Mailing Address - Fax:806-745-5171
Practice Address - Street 1:517 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-6337
Practice Address - Country:US
Practice Address - Phone:806-745-2551
Practice Address - Fax:806-745-5171
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571312279H0200X
NM24642279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health