Provider Demographics
NPI:1306124086
Name:ROBERT ODELL MD PHD MEDICAL ENTERPRISES
Entity type:Organization
Organization Name:ROBERT ODELL MD PHD MEDICAL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:702-257-7246
Mailing Address - Street 1:3540 W SAHARA AVE
Mailing Address - Street 2:368
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:702-257-7246
Mailing Address - Fax:702-254-7044
Practice Address - Street 1:8084 W SAHARA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2073
Practice Address - Country:US
Practice Address - Phone:702-257-7246
Practice Address - Fax:702-254-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFF097AMedicare PIN