Provider Demographics
NPI:1982657409
Name:ODYSSEY EMERGENCY MEDICAL, LLC
Entity Type:Organization
Organization Name:ODYSSEY EMERGENCY MEDICAL, LLC
Other - Org Name:ODYSSEY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-451-7161
Mailing Address - Street 1:10325 CYPRESSWOOD DR
Mailing Address - Street 2:PO BOX 1717
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3415
Mailing Address - Country:US
Mailing Address - Phone:713-664-5600
Mailing Address - Fax:866-206-2306
Practice Address - Street 1:10325 CYPRESSWOOD DR
Practice Address - Street 2:SUITE 1717
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3415
Practice Address - Country:US
Practice Address - Phone:713-664-5600
Practice Address - Fax:866-206-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101326341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163927001Medicaid
TXAMB339Medicare PIN