Provider Demographics
NPI:1952580433
Name:UMC PHYSICIAN NETWORK SERVICES
Entity Type:Organization
Organization Name:UMC PHYSICIAN NETWORK SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CENTRAL BUSINESS OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZINARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-761-0334
Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-761-0334
Mailing Address - Fax:806-722-2908
Practice Address - Street 1:4004 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1900
Practice Address - Country:US
Practice Address - Phone:806-722-3150
Practice Address - Fax:806-722-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTX078OtherBLUE CROSS BLUE SHIELD
TX147762201Medicaid
FTX078Medicare PIN