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Ty Whisenant

Student in an Organized Health Care Education/Training Program

Student, Health Care

3601 4th St # Ms 9410, Lubbock, TX 79430-0002

PECOS Enrollment

Based on the most recent information from CMS, provider Ty Whisenant is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1013575547
Provider Type
Individual
Full Name
Whisenant, Ty
Title
Dr.
Credential
MD, PHD

Gender
Male
Sole Proprietor
No
Enumeration Date
5/30/2019
Last Updated
5/30/2019

Contact Information

Practice Location

3601 4th St # Ms 9410, Lubbock, TX 79430-0002

(806) 743-6840

Unlisted Fax

Mailing Location

3601 4th St # Ms 9410, Lubbock, TX 79430-0002

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Ty Whisenant

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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