WEST TEXAS DIABETES AND ENDOCRINE CENTER PA NPI 1891900080

NPI Information

NPI: 1891900080
Provider Name: WEST TEXAS DIABETES AND ENDOCRINE CENTER PA
Classification: Family Medicine - 207QA0505X
Entity Type: Organization

Specialization: Adult Medicine

CLIA Number: 45D1079275

Address:
318 N ALLEGHANEY AVE STE 201
ODESSA, TX
ZIP 79761
Phone: (432) 332-1144
Get Directions

WEST TEXAS DIABETES AND ENDOCRINE CENTER PA is an adult medicine family medicine in Odessa, TX. The provider is the National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code. WEST TEXAS DIABETES AND ENDOCRINE CENTER PA NPI is 1891900080. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

318 N ALLEGHANEY AVE STE 201
ODESSA, TX
ZIP 79761-027
Phone: (432) 332-1144
Fax: (432) 337-2726

The provider's authorized official is Muralidhar Agusala .
The authorized official title is Administrator and has the following contact phone number (432) 332-1144.

The CLIA number assigned to this NPI record is 45D1079275 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/11/2007 and was last updated on 1/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		K6230	TEXAS	No
2	174400000X	Specialist		K6228	TEXAS	No
3	207RC0000X	Internal Medicine	Cardiovascular Disease	J1178	TEXAS	No
4	207QA0505X	Family Medicine	Adult Medicine	K3962	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	00349K	MEDICARE ID-TYPE UNSPECIFIED	TEXAS
2	00450L	MEDICARE PIN	TEXAS
3	030349701	MEDICAID	TEXAS
4	0A3984	MEDICARE PIN
5	080422101	MEDICAID	TEXAS
6	126502701	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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