Organization
TRICARE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICK D LAWLESS (OWNER GEN MGR)
(806) 894-0144
Entity
Organization
Contact information
Practice address
120 CLUBVIEW DR, LEVELLAND, TX 79336-6304
(806) 894-0144
(806) 894-6777
Mailing address
PO BOX 476, LEVELLAND, TX 79336-0476
(806) 894-0144
(806) 894-6777
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015824801
—
TX
05
—
086965301
—
TX
01
—
106613100
FIRST CARE
TX
01
—
509656
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/09/2006
Last updated
06/19/2012
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