Organization
DOUGLAS PARK I, LTD
Active
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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