Provider Demographics
NPI:1447451588
Name:SPENCER, HUBERT KENNETH
Entity type:Individual
Prefix:
First Name:HUBERT
Middle Name:KENNETH
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-1011
Mailing Address - Country:US
Mailing Address - Phone:806-236-2957
Mailing Address - Fax:806-331-3179
Practice Address - Street 1:2420 HOBBS RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1506
Practice Address - Country:US
Practice Address - Phone:806-236-2957
Practice Address - Fax:806-331-3179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0505210001Medicare NSC