Provider Demographics
NPI:1992248512
Name:LUBBOCK VASCULAR ACCESS CENTER
Entity type:Organization
Organization Name:LUBBOCK VASCULAR ACCESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, JD
Authorized Official - Phone:806-792-2222
Mailing Address - Street 1:1126 SLIDE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-5462
Mailing Address - Country:US
Mailing Address - Phone:806-792-2222
Mailing Address - Fax:806-792-8888
Practice Address - Street 1:1126 SLIDE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-5462
Practice Address - Country:US
Practice Address - Phone:806-792-2222
Practice Address - Fax:806-792-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14579261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical