MEDICARE: ODYSSEY HEALTHCARE OPERATING A LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	007361	IN

General Provider Information

NPI Number	:	1265578405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OPERATING A LP

Provider Business Mailing Address
First Line	:	717 N HARWOOD ST
Second Line	:	SUITE 1500
City	:	DALLAS
State	:	TX
Zip	:	75201-6519
Country	:	US
Telephone Number	:	214-922-9711
Fax Number	:	214-922-9752

Provider Business Practice Location Address
First Line	:	312 E DUPONT ROAD
Second Line	:	SUITE 200
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-2048
Country	:	US
Telephone Number	:	260-490-3330
Fax Number	:	260-490-3333

Authorized Official
Title or Position	:	SR VP & CFO
Name	:	MR. RODNEY DIRK ALLISON
Credential	:
Telephone Number	:	214-922-9711

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	11/05/2007

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