NPIMap

Organization Active NPI

Lubbock County Hospital District

Doing business as University Medical Center Pharmacy

  • Community/Retail Pharmacy
  • Lubbock, TX
National Provider Identifier
1679521652
Registry record updated Aug 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
6058 Issued in TX
Legal business name
LUBBOCK COUNTY HOSPITAL DISTRICT
Doing business as
University Medical Center Pharmacy
Practice address
602 Indiana Ave
Lubbock, TX 79415-3364
Phone
(806) 775-8696
Fax
(806) 775-8690
NPI assigned
May 4, 2006
Last updated
Aug 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2016

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

Authorized official

Name
Keith Moore, RPHNPI 1235196379
Title
Manager
Phone
(806) 775-8691

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 6058 TX Primary

Addresses

Primary practice location

602 Indiana Ave
Lubbock, TX 79415-3364

Mailing address

602 Indiana Ave
PO Box 5980
Lubbock, TX 79415-3364
Phone (806) 775-8691

Other identifiers 2

IdentifierTypeStateIssuer
250296MedicaidTX
2101370OtherPK

Other names 1

  • UNIVERSITY MEDICAL CENTER PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071211000708 TX Part A Provider - Hospital 3779493036 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lubbock, TX
O20100930011008 TX DME Supplier - Pharmacy 3779493036 Practice locations: Lubbock, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679521652. Details of each certification follow.

Hospital certification: CCN 450686

Legal name
LUBBOCK COUNTY HOSPITAL DISTRICT
Doing business as
UNIVERSITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 1, 1978
Last certification
Oct 30, 2025
Beds
503
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
602 Indiana Ave
University Medical Center
Lubbock, TX 79415-3364
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
University Medical CenterCCN 450686 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
U M C P a S12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Laura Vinson Individual Corporate Director Jan 1, 2021
Amy Eade Individual W-2 Managing Employee Jan 1, 2021
Phillip Waldmann Individual Corporate OfficerExecutive VP of Operations Jan 1, 2019
Lubbock County Hospital District Organization, Lubbock, TX Operational/Managerial Control Jun 2, 1978
Mont McClendon Individual Corporate DirectorDirector Jan 1, 2021
Mikella Newsom Individual Corporate Director Jan 1, 2024
Minor Mark Funderburk Individual Corporate DirectorPresident-Chief Executive Office Jan 1, 2018
Jason Medina Individual Corporate Director Jan 1, 2023
Jeffrey Dane Individual Corporate DirectorExecutive VP-Chief Financial Off Apr 1, 2002
Steven Maddux Individual Corporate DirectorSenior Vice President of Finance Apr 15, 2024
Gary Greenstreet Individual Corporate Director Jan 1, 2018
Gladys J Whitten Individual Corporate Director Jan 1, 2020
Karen Elaine Veselsky Individual Corporate OfficerVice President - Revenue Cycle Oct 21, 2024
Darren Payne Individual Corporate DirectorDirector Jan 1, 2025

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
University Medical CenterLubbock, TX, CCN 450686 Hospital Operational/Managerial Control Jun 2, 1978
South Plains Rehabilitation Hospital an Affiliate of Umc and EncompassLubbock, TX, CCN 673070 Hospital 5% Or Greater Direct Ownership Interest (50%) Oct 4, 2017
Umc Home Health and Hospice, an Amedisys PartnerLubbock, TX, CCN 748008 Home health agency 5% Or Greater Indirect Ownership Interest (50%) Aug 1, 2020
Umc Home Health and Hospice an Amedisys PartnerLubbock, TX, CCN 971631 Hospice 5% Or Greater Indirect Ownership Interest (50%) Aug 1, 2020

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 742

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 742

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471824000000",
    "number": "1679521652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 INDIANA AVE",
            "address_2": "PO BOX 5980",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794153364",
            "telephone_number": "806-775-8691",
            "fax_number": "806-775-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 INDIANA AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794153364",
            "telephone_number": "806-775-8696",
            "fax_number": "806-775-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBBOCK COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2016-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "806-775-8691",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "6058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250296",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2101370",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNIVERSITY MEDICAL CENTER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.