Provider Demographics
NPI:1821131855
Name:ODESSA HEART INSTITUTE
Entity Type:Organization
Organization Name:ODESSA HEART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANNINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-337-3117
Mailing Address - Street 1:720 GOLDER AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4442
Mailing Address - Country:US
Mailing Address - Phone:432-337-3117
Mailing Address - Fax:
Practice Address - Street 1:720 GOLDER AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4442
Practice Address - Country:US
Practice Address - Phone:432-337-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083732001Medicaid
TX083732001Medicaid
TXOOL39VMedicare ID - Type Unspecified