Provider Demographics
NPI:1720282841
Name:SOUTHWEST HEMATOLOGY ONCOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:SOUTHWEST HEMATOLOGY ONCOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULI
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-793-6654
Mailing Address - Street 1:4002 21ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1135
Mailing Address - Country:US
Mailing Address - Phone:806-793-6654
Mailing Address - Fax:806-793-7871
Practice Address - Street 1:4002 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1135
Practice Address - Country:US
Practice Address - Phone:806-793-6654
Practice Address - Fax:806-793-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A53WMedicare PIN
TX0553280001Medicare NSC