Provider Demographics
NPI:1043805625
Name:WEST TEXAS OBGYN
Entity Type:Organization
Organization Name:WEST TEXAS OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLARISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-888-7455
Mailing Address - Street 1:421 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5145
Mailing Address - Country:US
Mailing Address - Phone:432-888-7455
Mailing Address - Fax:432-888-7456
Practice Address - Street 1:421 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5145
Practice Address - Country:US
Practice Address - Phone:432-888-7455
Practice Address - Fax:432-888-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty