Provider Demographics
NPI:1700615259
Name:THE ODESSA BIRTH CENTER, PLLC
Entity type:Organization
Organization Name:THE ODESSA BIRTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, CNM
Authorized Official - Phone:432-363-4407
Mailing Address - Street 1:600 N WASHINGTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4436
Mailing Address - Country:US
Mailing Address - Phone:432-363-4407
Mailing Address - Fax:432-224-1442
Practice Address - Street 1:600 N WASHINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4436
Practice Address - Country:US
Practice Address - Phone:432-363-4407
Practice Address - Fax:432-224-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty