Basic Information
| Provider Information | |||||||||
| NPI: | 1730242801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPPS | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | TEXAS TECH UNIVERSITY STUDENT HEALTH CLINIC | ||||||||
| Address2: | 3601 4TH STREET-MS 7208 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432860 | ||||||||
| FaxNumber: | 8067432122 | ||||||||
| Practice Location | |||||||||
| Address1: | TEXAS TECH UNIVERSITY STUDENT HEALTH CLINIC | ||||||||
| Address2: | FLINT AND MAIN, TEXAS TECH UNIVERSITY CAMPUS | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432860 | ||||||||
| FaxNumber: | 8067432122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/25/2019 | ||||||||
| NPIReactivationDate: | 09/15/2022 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E0845 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P000AD517 | 05 | TX | MEDICAID |