Provider Demographics
NPI:1285747113
Name:SOUTH PLAINS RURAL HEALTH SERVICES INC
Entity type:Organization
Organization Name:SOUTH PLAINS RURAL HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-897-1987
Mailing Address - Street 1:1000 FARM MARKET RD 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-897-1987
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:1000 FARM MARKET RD 300
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6235
Practice Address - Country:US
Practice Address - Phone:806-897-1987
Practice Address - Fax:806-894-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4511691Medicare ID - Type Unspecified