Provider Demographics
NPI:1417633736
Name:PROCARE ODESSA LLC
Entity Type:Organization
Organization Name:PROCARE ODESSA LLC
Other - Org Name:EXCEL ER ODESSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-436-8100
Mailing Address - Street 1:6131 TX-191 FRONTAGE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-366-2911
Mailing Address - Fax:432-366-5416
Practice Address - Street 1:6131 TX-191 FRONTAGE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762
Practice Address - Country:US
Practice Address - Phone:432-366-2911
Practice Address - Fax:432-366-5416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care