Provider Demographics
NPI:1922398254
Name:LUBBOCK SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:LUBBOCK SPECIALTY HOSPITAL LLC
Other - Org Name:TEXAS SPECIALTY HOSPITAL AT LUBBOCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-723-8700
Mailing Address - Street 1:4302 PRINCETON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79415-1307
Mailing Address - Country:US
Mailing Address - Phone:806-723-8700
Mailing Address - Fax:806-723-8723
Practice Address - Street 1:4302 PRINCETON ST UNIT B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1307
Practice Address - Country:US
Practice Address - Phone:806-723-8700
Practice Address - Fax:806-723-8723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
452116Medicare Oscar/Certification