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General NPI Number Information
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NPI Number | 1396774535
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Entity Type | Organization
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Legal Business Name | ODESSA EAST LOOP SURGERY CENTER ,LP
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 155 SE LOOP 338 SUITE 500
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City | ODESSA
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State | TX
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Zip | 79762-9703
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Country | US
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Telephone | 432-367-3906
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Fax | 432-367-3895
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Provider Business Mailing Address
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Address Line | 155 SE LOOP 338 SUITE 500
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City | ODESSA
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State | TX
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Zip | 79762-9703
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Country | US
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Telephone | 432-367-3906
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Fax | 432-367-3895
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Authorized Official
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Title or Position | CEO
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Name | CHRIS FLORES
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Credential |
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Telephone | 432-367-3906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007262
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License Number State | TX
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