Provider Demographics
NPI:1821884750
Name:CENTRAL PRAIRIE PHYSICIANS PLLC
Entity type:Organization
Organization Name:CENTRAL PRAIRIE PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-829-6610
Mailing Address - Street 1:1602 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4732
Practice Address - Country:US
Practice Address - Phone:888-264-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty