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General NPI Number Information
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NPI Number | 1073200473
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Entity Type | Organization
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Legal Business Name | FREEDOM 7419 LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 4803 PLAZA BLVD BLDG 1
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City | ODESSA
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State | TX
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Zip | 79762-4913
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Country | US
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Telephone | 432-312-1056
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Fax |
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Provider Business Mailing Address
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Address Line | 6623 PATRIOT PKWY
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City | MIDLAND
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State | TX
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Zip | 79706-3150
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Country | US
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Telephone | 432-312-1056
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | MELONYE ADKINS HUBER
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Credential | RN
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Telephone | 432-994-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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