Provider Demographics
NPI:1588997225
Name:CONSULTANTS IN INFECTIOUS DISEASES
Entity type:Organization
Organization Name:CONSULTANTS IN INFECTIOUS DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:806-795-8150
Mailing Address - Street 1:PO BOX 16327
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79490-6327
Mailing Address - Country:US
Mailing Address - Phone:806-795-8150
Mailing Address - Fax:806-791-6688
Practice Address - Street 1:4404 19TH ST
Practice Address - Street 2:STE. C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2424
Practice Address - Country:US
Practice Address - Phone:806-795-8150
Practice Address - Fax:806-791-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15037261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082062301OtherFIRST CARE STAR
G9939OtherNEW MEXICO MEDICAID
TX082062301Medicaid
TX750678OtherBCBS HOME INFUSION THERAPY
TX0541920001OtherPALMETTO GBA
082062301OtherFIRST CARE STAR
TX103131100OtherFIRST CARE
TX082062301Medicaid
TX00D66CMedicare PIN