NPIMap

Organization Active NPI

Community Health Center of Lubbock, Inc

  • Federally Qualified Health Center (FQHC)
  • Lubbock, TX
National Provider Identifier
1891768321
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC
Practice address
406 MLK Blvd
Lubbock, TX 79403
Phone
(806) 767-9744
Fax
(806) 767-9930
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Mr. Michael P. Sullivan
Title
Chief Executive Officer
Phone
(806) 765-2611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

406 MLK Blvd
Lubbock, TX 79403

Mailing address

1610 5TH St
Lubbock, TX 79401-2622
Phone (806) 765-2611

Other identifiers 1

IdentifierTypeStateIssuer
019021710MedicaidTX

Other names 1

  • Parkway Community Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040907001161 TX Part A Provider - Federally Qualified Health Center (FQHC) 6002710860 Practice locations: Lubbock, TX
O20180731002269 TX Part B Supplier - Clinic/Group Practice 6002710860 Receives reassigned benefits from 18 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lubbock, TX

Federally qualified health center certification: CCN 451975

Legal name
COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Doing business as
PARKWAY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 9, 2004
Last certification
Sep 9, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1992 in TX
Enrollment address
406 MLK Blvd
Lubbock, TX 79403-5210

Other NPIs with the same Medicare PAC ID 6

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.

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center12 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.

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Michael P Sullivan Individual Corporate OfficerChief Executive Officer Jul 1, 1998 100%
W-2 Managing EmployeeChief Executive Officer Jul 1, 1998 100%
D. Melynn Henry Individual Corporate DirectorBoard of Director Mar 15, 2016 100%
Brandon Hartley Individual Corporate DirectorSecretary Mar 15, 2016 100%
Aaron S. Davis Individual Corporate DirectorBoard Member May 21, 2019 100%
Elizabeth Lopez Individual Corporate OfficerChief Development Officer/Deputy Nov 9, 1999
Corporate DirectorChief Development Officer/Deputy Nov 9, 1999 100%
W-2 Managing EmployeeChief Development Officer/Deputy Nov 9, 1999
James a Johnson Individual Corporate DirectorPresident Dec 21, 2010 100%
Bertha Martinez Individual Corporate DirectorPast President Feb 15, 2005 100%
Barbra C Moore Individual Corporate DirectorFinance Director Dec 21, 2016
W-2 Managing EmployeeFinance Director Oct 16, 2012
Margaret J Gaines Individual Corporate DirectorBoard Member Dec 16, 2008 100%
Patricia a Mora Individual Corporate DirectorBoard Member Aug 10, 2003 100%
Mike a Chapman Individual Corporate DirectorBoard Member Nov 20, 2012 100%
Allan C Camacho Individual Corporate DirectorMedical Director Mar 1, 2017
W-2 Managing EmployeeMedical Director/Staff Dentist Mar 1, 2017 100%
Gilbert Michael Godinez Individual Corporate DirectorBoard Member May 18, 2021 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1891768321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 5TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794012622",
            "telephone_number": "806-765-2611",
            "fax_number": "806-687-5826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 MLK BLVD",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "79403",
            "telephone_number": "806-767-9744",
            "fax_number": "806-767-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF LUBBOCK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "806-765-2611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019021710",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkway Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parkway Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lubbock, TX

Sources for this page

Verify at the official NPI Registry.