Provider Demographics
NPI:1679944987
Name:LUBBOCK DIGESTIVE DISEASE ASSOCIATES
Entity type:Organization
Organization Name:LUBBOCK DIGESTIVE DISEASE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-793-3141
Mailing Address - Street 1:3610 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2014
Mailing Address - Country:US
Mailing Address - Phone:806-793-3141
Mailing Address - Fax:806-771-2235
Practice Address - Street 1:3610 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2014
Practice Address - Country:US
Practice Address - Phone:806-793-3141
Practice Address - Fax:806-771-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty