Provider Demographics
NPI:1144333063
Name:SOUTH PLAINS RURAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:SOUTH PLAINS RURAL HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-894-7842
Mailing Address - Street 1:1000 FM 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-897-1987
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:1005 NORTH 16TH STREET
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-3151
Practice Address - Country:US
Practice Address - Phone:806-872-6310
Practice Address - Fax:806-872-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180034401Medicaid
TX019049801Medicaid
TX386569302Medicaid