MEDICARE: ODYSSEY HEALTHCARE OPERATING B 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	092194H	GA

General Provider Information

NPI Number	:	1629079207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODYSSEY HEALTHCARE OPERATING B 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	:	1001 WILLIAMS ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-4038
Country	:	US
Telephone Number	:	229-249-8687
Fax Number	:	229-249-9282

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/01/2007

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