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NPI Code Detail

MEDICARE: TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER ODESSA

MEDICARE: TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER ODESSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207V00000XObstetrics & Gynecology Physician
3208000000XPediatrics Physician
4208600000XSurgery Physician
5332B00000XDurable Medical Equipment & Medical Supplies
6207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407845084
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER ODESSA
Provider Business Mailing Address
First Line : 701 W 5TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79763-4206
Country : US
Telephone Number : 432-703-5004
Fax Number : 432-335-1807
Provider Business Practice Location Address
First Line : 701 W 5TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79763-4206
Country : US
Telephone Number : 432-335-2222
Fax Number :
Authorized Official
Title or Position : EXECUTIVE ASSOCIATE DEAN
Name : JOCELYN PICCONE
Credential :
Telephone Number : 432-620-1036
Provider Enumeration Date : 10/17/2005
Last Update Date : 08/09/2017

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Directions to “TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER ODESSA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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