Provider Demographics
NPI:1427611854
Name:SOUTH CENTRAL PHYSICIANS PLLC
Entity type:Organization
Organization Name:SOUTH CENTRAL PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-264-0330
Mailing Address - Street 1:1602 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-4732
Mailing Address - Country:US
Mailing Address - Phone:888-264-0330
Mailing Address - Fax:
Practice Address - Street 1:1602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4732
Practice Address - Country:US
Practice Address - Phone:888-264-0330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100808000Medicaid
KY7100763470Medicaid
KY7100770390Medicaid