NPIMap

Organization Active NPI

Texas Tech University Health Sciences Center Lubbock

  • Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
  • Lubbock, TX
National Provider Identifier
1164979142
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianTaxonomy code 2084D0003X
License
Q8817 Issued in TX
Legal business name
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
Practice address
1008 Canton Ave
Room 018BF
Lubbock, TX 79409-3132
Phone
(806) 742-3400
NPI assigned
Sep 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yazan Alderazi, MD
Title
Faculty
Phone
(806) 743-2391

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084D0003X Q8817 TX Primary

Addresses

Primary practice location

1008 Canton Ave
Room 018BF
Lubbock, TX 79409-3132

Mailing address

PO Box 27476
Salt Lake City, UT 84127-0476
Phone (806) 743-4263

Other names 1

  • Texas Tech Neuroimaging Institute Other name

National Provider Directory

National Provider Directory
Tax ID family
Rehabilitation Services -School of Allied Health Sciences21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

1008 Canton Ave
Rm 18BF
Lubbock, TX 79409
Phone (806) 742-3400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569888000000",
    "number": "1164979142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27476",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270476",
            "telephone_number": "806-743-4263",
            "fax_number": "806-743-5687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 CANTON AVE",
            "address_2": "ROOM 018BF",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794093132",
            "telephone_number": "806-742-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2019-10-01",
        "status": "A",
        "authorized_official_last_name": "ALDERAZI",
        "authorized_official_first_name": "YAZAN",
        "authorized_official_title_or_position": "FACULTY",
        "authorized_official_telephone_number": "806-743-2391",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Diagnostic Neuroimaging",
            "state": "TX",
            "license": "Q8817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Texas Tech Neuroimaging Institute",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Texas Tech Neuroimaging Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.