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General NPI Number Information
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NPI Number | 1629386784
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Entity Type | Organization
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Legal Business Name | ODESSA ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 315 E 5TH ST
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City | ODESSA
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State | TX
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Zip | 79761-5133
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Country | US
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Telephone | 432-335-8300
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Fax | 432-335-8330
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Provider Business Mailing Address
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Address Line | 315 E 5TH ST
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City | ODESSA
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State | TX
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Zip | 79761-5133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MR. PETER BLACH
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Credential |
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Telephone | 713-343-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007948
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License Number State | TX
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