Organization
DOUGLAS PARK I, LTD
Active
Other names
Odessa Kidney Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS PARK M.D. (MEDICAL DIRECTOR)
(432) 687-4044
Entity
Organization
Contact information
Practice address
6005 EASTRIDGE RD, ODESSA, TX 79762-5019
(432) 550-6012
(432) 550-7201
Mailing address
6005 EASTRIDGE RD, ODESSA, TX 79762-5019
(432) 550-6012
(432) 550-7201
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
008017
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH7000
BC/BS
TX
Enumeration date
12/02/2005
Last updated
08/22/2020
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