Provider Demographics
NPI:1932611969
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DEAN OF FINANCE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-743-1830
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-743-3490
Mailing Address - Fax:
Practice Address - Street 1:4102 24TH ST STE 507
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1805
Practice Address - Country:US
Practice Address - Phone:806-743-7980
Practice Address - Fax:806-743-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140327146Medicaid
TX084589302Medicaid