Healthcare Provider Details

I. General information

NPI: 1316376239
Provider Name (Legal Business Name): ODESSA FERTILITY LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 6TH ST
ODESSA TX
79761-4527
US

IV. Provider business mailing address

117 SEABOARD LN BLDG E ATTN; IASIS CORPORATE LEGAL DEPARTMENT
FRANKLIN TN
37067-2855
US

V. Phone/Fax

Practice location:
  • Phone: 432-582-8672
  • Fax: 432-582-8971
Mailing address:
  • Phone: 615-844-2747
  • Fax: 615-467-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STACEY L GERIG
Title or Position: OFFICER
Credential:
Phone: 432-582-8200