Organization · Type 2 NPI

Ttuhsc Managed Care

Prison Health Clinic/Center · Lubbock, TX

NPI number 1104490556 Active

Practice location

1215 Avenue J
Lubbock, TX 79401-4038

Specialties and licenses

Taxonomy	Code	License
Prison Health Clinic/Center Primary	261QP2400X	None listed

Prison Health Clinic/Center: Definition to come...

Another provider at this address

Donny Wayne Knighten, APRNPsychiatric/Mental Health Nurse Practitioner Lubbock, TX NPI 1295300838

NPI record

NPI: 1104490556
Entity type: Organization (Type 2)
Issued: May 19, 2021
Last updated: May 24, 2021
Status: Active
Subpart: Yes of Texas Tech University Health Sciences Center

Other names

Ttuhsc Managed Care · former legal business name

Authorized official

Mr. Will Rodriguez
Managed Care Executive Director
(806) 743-3280

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104490556

Ttuhsc Managed Care's National Provider Identifier is 1104490556, issued on May 19, 2021. The primary taxonomy on file is Prison Health Clinic/Center (261QP2400X), and the practice location is in Lubbock, TX. The record was last updated on May 24, 2021.