Provider Demographics
NPI:1316376239
Name:ODESSA FERTILITY LAB INC
Entity type:Organization
Organization Name:ODESSA FERTILITY LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GERIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-582-8200
Mailing Address - Street 1:117 SEABOARD LN BLDG E
Mailing Address - Street 2:ATTN; IASIS CORPORATE LEGAL DEPARTMENT
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2855
Mailing Address - Country:US
Mailing Address - Phone:615-844-2747
Mailing Address - Fax:615-467-1271
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:432-582-8672
Practice Address - Fax:432-582-8971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory