Provider Demographics
NPI:1750702015
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER - SON - LUBBOCK
Entity type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER - SON - LUBBOCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-743-9355
Mailing Address - Street 1:301 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79404-2746
Mailing Address - Country:US
Mailing Address - Phone:806-743-9355
Mailing Address - Fax:806-743-9363
Practice Address - Street 1:6501 UNIVERSITY AVE STE 600
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5849
Practice Address - Country:US
Practice Address - Phone:806-743-2424
Practice Address - Fax:806-743-9633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER - SON - LUBBOCK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741841OtherMEDICARE PIN
TX333188601Medicaid
TX333188602Medicaid
TX333188601Medicaid