Provider Demographics
NPI:1366526220
Name:CONIFERCARE, INC.
Entity type:Organization
Organization Name:CONIFERCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JEWEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-771-4124
Mailing Address - Street 1:4202 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2405
Mailing Address - Country:US
Mailing Address - Phone:806-771-4124
Mailing Address - Fax:806-771-4126
Practice Address - Street 1:4202 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2405
Practice Address - Country:US
Practice Address - Phone:806-771-4124
Practice Address - Fax:806-771-4126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67-5351302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization