Provider Demographics
NPI:1407390180
Name:ODESSA SURGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:ODESSA SURGICAL SERVICES, PLLC
Other - Org Name:DARREN GLASS MD SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-653-0094
Mailing Address - Street 1:540 W 5TH ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5034
Mailing Address - Country:US
Mailing Address - Phone:432-653-0094
Mailing Address - Fax:432-580-8333
Practice Address - Street 1:540 W 5TH ST
Practice Address - Street 2:SUITE 470
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-653-0094
Practice Address - Fax:432-580-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX392846937261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center