Healthcare Provider Details

I. General information

NPI: 1740701184
Provider Name (Legal Business Name): OGEDA FAMILY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 BRIARWOOD AVE STE A
MIDLAND TX
79707-2642
US

IV. Provider business mailing address

PO BOX 8148
MIDLAND TX
79708-8148
US

V. Phone/Fax

Practice location:
  • Phone: 432-689-6818
  • Fax: 432-689-6901
Mailing address:
  • Phone: 432-689-6818
  • Fax: 432-689-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberM3675
License Number StateTX

VIII. Authorized Official

Name: MARIVEL CATANO
Title or Position: CLINIC OFFICE MANAGER
Credential:
Phone: 432-689-6818