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620 N Grant Ave Suite 1012 Odessa TX 79761-4541 | |
| (502) 394-2100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 620 N Grant Ave, Odessa, Texas |
| Authorized Official Name and Position | Timothy Whobrey (PROVIDER ENROLLMENT) |
| Authorized Official Contact | 5026307249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
805 N Whittington Pkwy Louisville KY 40222-7101 Ph: (502) 394-2100 | 620 N Grant Ave Suite 1012 Odessa TX 79761-4541 Ph: (502) 394-2100 |
| NPI Number | 1730520131 |
|---|---|
| Provider Enumeration Date | 07/13/2013 |
| Last Update Date | 02/02/2021 |
| Certification Date | 02/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730520131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Texas) | Primary |
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