# WEST TEXAS DIABETES AND ENDOCRINE CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WEST TEXAS DIABETES AND ENDOCRINE CENTER PA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891900080
- **Legal business name:** WEST TEXAS DIABETES AND ENDOCRINE CENTER PA
- **Authorized official:** MR. MURALIDHAR AGUSALA (ADMINISTRATOR)
- **Authorized official phone:** (432) 332-1144

## Contact information

- **Practice address:** 318 N ALLEGHANEY AVE STE 201, ODESSA, TX 79761-5027
- **Practice address phone:** (432) 332-1144
- **Practice address fax:** (432) 337-2726
- **Mailing address:** 318 N ALLEGHANEY AVE STE 201, ODESSA, TX 79761-5027
- **Mailing address phone:** (432) 332-1144
- **Mailing address fax:** (432) 337-2726

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | K6228 | TX | — |
| 174400000X | Specialist | K6230 | TX | — |
| 207QA0505X | Adult Medicine Physician | K3962 | TX | Yes |
| 207RC0000X | Cardiovascular Disease Physician | J1178 | TX | — |

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 01/11/2011