Provider Demographics
NPI:1487668745
Name:ODYSSEY MEDICAL ASSOCIATES LLLP
Entity Type:Organization
Organization Name:ODYSSEY MEDICAL ASSOCIATES LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTHOORI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-492-1700
Mailing Address - Street 1:PO BOX 36670
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6670
Mailing Address - Country:US
Mailing Address - Phone:702-492-1700
Mailing Address - Fax:702-492-6816
Practice Address - Street 1:2610 W HORIZON RIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2870
Practice Address - Country:US
Practice Address - Phone:702-492-1700
Practice Address - Fax:702-492-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty