| University Clinic | |
|
111 University Ave Lubbock TX 79415 | |
| (806) 747-4415 | |
| (806) 747-1304 |
| Full Name | University Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 111 University Ave, Lubbock, Texas |
| Authorized Official Name and Position | Diego Rivera (OWNER) |
| Authorized Official Contact | 8067474415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| University Clinic 111 University Ave Lubbock TX 79415 Ph: (806) 747-4415 | University Clinic 111 University Ave Lubbock TX 79415 Ph: (806) 747-4415 |
| NPI Number | 1851575906 |
|---|---|
| Provider Enumeration Date | 12/26/2007 |
| Last Update Date | 05/07/2008 |
| Medicare PECOS PAC ID | 9638330426 |
|---|---|
| Medicare Enrollment ID | O20120423000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851575906 | NPI | - | NPPES |
| 010066279 | Other | TX | RAILROAD MEDICARE |
| 158775001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G1757 (Texas) | Primary |
| Provider Name | Diego Rivera |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1104984988 PECOS PAC ID: 4183886567 Enrollment ID: I20120501000363 |
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