Organization
MCH PROFESSIONAL CARE
Active
Parent organization
MCH PROFESSIONAL CARE
Other names
MCH Professional Care Anesthesia
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCH PROFESSIONAL CARE
Authorized official
JENNIFER ELLEN CONWAY (ASSISTANT DIRECTOR)
(432) 640-2401
Entity
Organization
Contact information
Practice address
500 W 4TH ST, ODESSA, TX 79761-5001
(432) 640-2401
Mailing address
PO BOX 643, INDIANAPOLIS, IN 46206-0643
(432) 640-2401
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0065JH
BLUE CROSS BLUE SHIELD
TX
05
—
197485901
—
TX
Enumeration date
02/18/2008
Last updated
04/01/2009
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