Provider Demographics
NPI:1154545036
Name:LUBBOCK KIDNEY AND BLOOD PRESSURE CLINIC PA
Entity type:Organization
Organization Name:LUBBOCK KIDNEY AND BLOOD PRESSURE CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:806-793-8447
Mailing Address - Street 1:1126 SLIDE ROAD
Mailing Address - Street 2:SUITE 4-B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416
Mailing Address - Country:US
Mailing Address - Phone:806-793-8447
Mailing Address - Fax:806-792-7887
Practice Address - Street 1:1126 SLIDE RD
Practice Address - Street 2:SUITE 4-B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5402
Practice Address - Country:US
Practice Address - Phone:806-793-8447
Practice Address - Fax:890-679-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5737410001Medicare NSC