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Organization
LUBBOCK RADIOLOGY LP
Active
Organization
LUBBOCK RADIOLOGY LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONTY MEDANICH (COO)
(806) 792-2767
Entity
Organization
Contact information
Practice address
3707 21ST ST, LUBBOCK, TX 79410-1219
(806) 792-2767
(806) 791-6709
Mailing address
PO BOX 2160, LUBBOCK, TX 79408-2160
(806) 792-2767
(806) 791-6709
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
TX
293D00000X
Physiological Laboratory
Primary
—
TX
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104497100
FIRSTCARE
TX
05
—
153651801
—
TX
01
—
1895212
FIRST HEALTH
—
01
—
470001572
RR MEDICARE
—
01
—
J730
BLUE CROSS
TX
05
—
W6027
—
NM
Enumeration date
06/24/2005
Last updated
11/03/2021
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