MEDICARE: PEDICARE CHILDRENS URGENT CARE PA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1285165332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDICARE CHILDRENS URGENT CARE PA

Provider Business Mailing Address
First Line	:	912 E 5TH ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4605
Country	:	US
Telephone Number	:	432-334-8845
Fax Number	:	432-334-8875

Provider Business Practice Location Address
First Line	:	6326 YORKTOWN BLVD STE 1B
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-5861
Country	:	US
Telephone Number	:	361-334-0613
Fax Number	:	361-334-0374

Authorized Official
Title or Position	:	OWNER
Name	:	KOLAWOLE ODUMUSI
Credential	:	MD
Telephone Number	:	432-695-6300

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	02/16/2026

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