Provider Demographics
NPI:1750414041
Name:SOUTH PLAINS DIAGNOSTIC, LLC
Entity type:Organization
Organization Name:SOUTH PLAINS DIAGNOSTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-795-1222
Mailing Address - Street 1:5009 UNIVERSITY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4431
Mailing Address - Country:US
Mailing Address - Phone:806-795-1222
Mailing Address - Fax:806-795-1191
Practice Address - Street 1:5009 UNIVERSITY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4431
Practice Address - Country:US
Practice Address - Phone:806-795-1222
Practice Address - Fax:806-795-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR27457247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459889Medicare ID - Type Unspecified