Basic Information
| Provider Information | |||||||||
| NPI: | 1932589652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ODESSA PHYSICIAN ASSOCIATES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S PARK RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330218593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776935700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 E 4TH ST | ||||||||
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| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797615255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4323629930 | ||||||||
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| ProviderEnumerationDate: | 06/08/2015 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHILLINGER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8776935700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.