Organization
LUBBOCK DIAGNOSTIC RADIOLOGY, L.L.P.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONTY MEDANICH (C.O.O.)
(806) 792-2767
Entity
Organization
Contact information
Practice address
4005 24TH ST, LUBBOCK, TX 79410-1835
(806) 792-2767
(888) 861-8858
Mailing address
PO BOX 1620, LUBBOCK, TX 79408-1620
(806) 792-2767
(806) 791-6709
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0094EE
BLUE CROSS
TX
05
—
095055202
—
TX
01
—
62866
NEW MEXICO MEDICAID
—
01
—
CG7043
RAILROAD MEDICARE
—
Enumeration date
09/28/2006
Last updated
11/04/2021
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