Organization
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Active
Organization
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Active
Other names
CHCL West Medical & Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL P. SULLIVAN CPA (CHIEF EXECUTIVE OFFICER)
(806) 765-2611
Entity
Organization
Contact information
Practice address
5424 19TH ST STE 200, LUBBOCK, TX 79407
(806) 722-4453
(806) 722-4461
Mailing address
1610 5TH ST, LUBBOCK, TX 79401-2622
(806) 765-2611
(806) 687-5826
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019021716
—
TX
01
—
741815
MEDICARE
TX
Enumeration date
03/29/2012
Last updated
02/07/2022
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