| Organization Name: | LUBBOCK PLASTIC SURGERY CENTER, LP |
| NPI Number: | 1003264425 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHAD RICKY SOUTHARD (ADMINISTRATOR) |
| Mailing Address: | 10105 Quaker Ave Lubbock |
| State: | TX US |
| Postal Code: | 794247380 |
| Phone Number: | 8067976398 |
| Fax Number: | 8067976399 |
| NPI Enumeration Date: | 05/26/2016 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |