| 96 West | |
|
2401 Fulton Ave Apt B Lubbock TX 79407-7727 | |
| (806) 765-2600 | |
| Not Available |
| Full Name | 96 West |
|---|---|
| Speciality | Clinic/Center |
| Location | 2401 Fulton Ave Apt B, Lubbock, Texas |
| Authorized Official Name and Position | Michael Sullivan (CEO) |
| Authorized Official Contact | 8067652611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 96 West 1610 5th St Lubbock TX 79401-2622 Ph: (806) 765-2611 | 96 West 2401 Fulton Ave Apt B Lubbock TX 79407-7727 Ph: (806) 765-2600 |
| NPI Number | 1740551787 |
|---|---|
| Provider Enumeration Date | 01/23/2012 |
| Last Update Date | 02/07/2022 |
| Certification Date | 02/07/2022 |
| Medicare PECOS PAC ID | 6002710860 |
|---|---|
| Medicare Enrollment ID | O20120606000751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740551787 | NPI | - | NPPES |
| 295467901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | () | Primary |
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