Provider Demographics
NPI:1972505147
Name:LUBBOCK ARTIFICIAL LIMB & BRACE LTD
Entity Type:Organization
Organization Name:LUBBOCK ARTIFICIAL LIMB & BRACE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-799-1518
Mailing Address - Street 1:7619 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2125
Mailing Address - Country:US
Mailing Address - Phone:806-799-1518
Mailing Address - Fax:806-799-5462
Practice Address - Street 1:7619 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2125
Practice Address - Country:US
Practice Address - Phone:806-799-1518
Practice Address - Fax:806-799-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000060335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145567701Medicaid
NMT6061Medicaid
KS100386640AMedicaid
TX015455101Medicaid
TX145567701Medicaid