Basic Information
| Provider Information | |||||||||
| NPI: | 1376729004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ODESSA CONSULTANTS, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CENTER FOR HYPERTENSION AND INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3992 | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797603992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325822446 | ||||||||
| FaxNumber: | 4325822960 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 E 6TH ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797614529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4325822446 | ||||||||
| FaxNumber: | 4325822960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 04/09/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAMGANAMAMULA | ||||||||
| AuthorizedOfficialFirstName: | MADHU | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4325822446 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ODESSA CONSULTANTS, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | L1155 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.