Provider Demographics
NPI:1720299381
Name:WEST TEXAS DIGESTIVE DISEASE CENTER, PA
Entity Type:Organization
Organization Name:WEST TEXAS DIGESTIVE DISEASE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL KHARRAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-788-4368
Mailing Address - Street 1:PO BOX 93128
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79493-3128
Mailing Address - Country:US
Mailing Address - Phone:806-788-4368
Mailing Address - Fax:806-788-4369
Practice Address - Street 1:5115 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3017
Practice Address - Country:US
Practice Address - Phone:806-788-4368
Practice Address - Fax:806-788-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X, 363L00000X, 363LF0000X, 367500000X
TXL8588261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y137Medicare PIN