Basic Information
Provider Information
NPI: 1669418547
EntityType: 2
ReplacementNPI:  
OrganizationName: UMC PHYSICIANS
LastName:  
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Mailing Information
Address1: 5219 CITY BANK PKWY
Address2: SUITE 160
City: LUBBOCK
State: TX
PostalCode: 794073544
CountryCode: US
TelephoneNumber: 8067610333
FaxNumber: 8067857685
Practice Location
Address1: 5219 CITY BANK PKWY STE 135
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794073595
CountryCode: US
TelephoneNumber: 8067610333
FaxNumber: 8067857685
Other Information
ProviderEnumerationDate: 06/21/2006
LastUpdateDate: 10/06/2022
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: GUARDIOLA
AuthorizedOfficialFirstName: MARCO
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MANAGING DIRECTOR, BUSINESS SERVICE
AuthorizedOfficialTelephone: 8067610333
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate: 10/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 
207RG0100X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
208000000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 
363A00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363LF0000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
L037605NM MEDICAID
07987790205TX MEDICAID
CD249801TXRAILROAD MEDICAREOTHER
00U84U01TXBCBSOTHER


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