=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821131855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODESSA HEART INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 01/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 GOLDER AVE
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-337-3117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 GOLDER AVE
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-337-3117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DANNINE GARVEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 432-337-3117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------