Organization
METHODIST DIAGNOSTIC IMAGING
Active
Other names
COVENANT DIAGNOSTIC IMAGING
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
3525 19TH ST, LUBBOCK, TX 79410-1202
(806) 792-2767
(806) 791-6709
Mailing address
PO BOX 2190, LUBBOCK, TX 79408-2190
(806) 792-2767
(806) 791-6709
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
N/A
TX
261QR0200X
Radiology Clinic/Center
Primary
N/A
TX
293D00000X
Physiological Laboratory
N/A
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103173100
FIRSTCARE
TX
05
—
121741601
—
TX
01
—
121741603
CROSSOVERMEDICAID
TX
01
—
DN6474
RAILROAD MEDICARE
—
05
—
G7966
—
NM
01
—
OOF91Y
BLUE CROSS
TX
Enumeration date
06/29/2005
Last updated
05/07/2025
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