Provider Demographics
NPI:1962567107
Name:UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:UNIVERSITY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, MSN, NNP
Authorized Official - Phone:806-441-0306
Mailing Address - Street 1:3001 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2332
Mailing Address - Country:US
Mailing Address - Phone:806-441-0306
Mailing Address - Fax:
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657913282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital