Provider Demographics
NPI:1386950582
Name:LUBBOCK LIGHTHOUSE
Entity type:Organization
Organization Name:LUBBOCK LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:806-744-3419
Mailing Address - Street 1:1308 AVENUE Q STE A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3839
Mailing Address - Country:US
Mailing Address - Phone:806-744-3419
Mailing Address - Fax:806-747-1384
Practice Address - Street 1:1308 AVENUE Q STE A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-3839
Practice Address - Country:US
Practice Address - Phone:806-744-3419
Practice Address - Fax:806-747-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000011302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization