Provider Demographics
NPI:1215910633
Name:LUBBOCK CARDIOLOGY SPECIALISTS, PA
Entity type:Organization
Organization Name:LUBBOCK CARDIOLOGY SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-788-0040
Mailing Address - Street 1:4802 N LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3025
Mailing Address - Country:US
Mailing Address - Phone:806-788-0040
Mailing Address - Fax:806-784-4202
Practice Address - Street 1:4802 N LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3025
Practice Address - Country:US
Practice Address - Phone:806-788-0040
Practice Address - Fax:806-788-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085725201Medicaid
TX085725201Medicaid