Organization Name: | INNOVATIVE DIALYSIS CENTER OF LUBBOCK, LLC |
NPI Number: | 1013306133 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS L. WEINBERG (AUTHORIZED REPRESENTATIVE) |
Mailing Address: | 1826 Parkway Dr Lubbock |
State: | TX US |
Postal Code: | 794034406 |
Phone Number: | 8067471366 |
Fax Number: | 8067442026 |
NPI Enumeration Date: | 01/13/2015 |
NPI Last Update Date: | 01/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |