Provider Demographics
NPI:1689838245
Name:ODESSA REGIONAL HOSPITAL LP
Entity Type:Organization
Organization Name:ODESSA REGIONAL HOSPITAL LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-582-8000
Mailing Address - Street 1:520 E 6TH ST
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4527
Mailing Address - Country:US
Mailing Address - Phone:432-582-8000
Mailing Address - Fax:432-582-8900
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:432-582-8790
Practice Address - Fax:432-582-8791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ODESSA REGIONAL HOSPITAL LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-14
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T661Medicare Oscar/Certification