Basic Information
| Provider Information | |||||||||
| NPI: | 1093744989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACK H. HENRY MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16585 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794906585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067852045 | ||||||||
| FaxNumber: | 8067850872 | ||||||||
| Practice Location | |||||||||
| Address1: | 4004 82ND ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794231900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067925500 | ||||||||
| FaxNumber: | 8067223103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARRISON | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | COORDINATOR, MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 8067857676 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | D1880 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.