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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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