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General NPI Number Information
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NPI Number | 1174929087
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL LOCUM TENENS
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 900 E 4TH ST
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City | ODESSA
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State | TX
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Zip | 79761-5255
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Country | US
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Telephone | 432-556-4817
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Fax | 432-563-2071
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Provider Business Mailing Address
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Address Line | 2808 S COUNTY ROAD 1257
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City | MIDLAND
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State | TX
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Zip | 79706-2847
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Country | US
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Telephone | 432-553-3117
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Fax | 432-563-2071
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Authorized Official
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Title or Position | CEO
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Name | DR. DANIEL H. KINZIE IV
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Credential | MD
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Telephone | 432-553-3117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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