Provider Demographics
NPI:1922988690
Name:ODESSA PRIMARY CARE PLLC
Entity type:Organization
Organization Name:ODESSA PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-439-3165
Mailing Address - Street 1:601 GOLDER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4412
Mailing Address - Country:US
Mailing Address - Phone:866-439-3165
Mailing Address - Fax:832-413-4493
Practice Address - Street 1:601 GOLDER AVE STE B
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4412
Practice Address - Country:US
Practice Address - Phone:866-439-3165
Practice Address - Fax:832-413-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty