Provider Demographics
NPI:1487887287
Name:ODYSSEY ANESTHESIA PA
Entity type:Organization
Organization Name:ODYSSEY ANESTHESIA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-7460
Mailing Address - Street 1:4100 INTERNATIONAL PLZ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4820
Mailing Address - Country:US
Mailing Address - Phone:972-668-7460
Mailing Address - Fax:972-668-7467
Practice Address - Street 1:1616 CAMINO LAGO
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3212
Practice Address - Country:US
Practice Address - Phone:972-668-7460
Practice Address - Fax:972-668-7467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty