Provider Demographics
NPI:1720277437
Name:WEST TEXAS LUNG CLINIC PA
Entity Type:Organization
Organization Name:WEST TEXAS LUNG CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-670-4033
Mailing Address - Street 1:1904 PINE ST
Mailing Address - Street 2:STE. 4C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2449
Mailing Address - Country:US
Mailing Address - Phone:325-670-4033
Mailing Address - Fax:325-670-4051
Practice Address - Street 1:1904 PINE ST
Practice Address - Street 2:STE. 4C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2449
Practice Address - Country:US
Practice Address - Phone:325-670-4033
Practice Address - Fax:325-670-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7622207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079MQOtherBC/BS
TX124859101OtherFIRST CARE
TX175257801Medicaid
TX124859101OtherFIRST CARE
TXH11711Medicare UPIN