Douglas Park I, LTD

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

008017 Issued in TX

Legal business name

DOUGLAS PARK I, LTD

Practice address

6005 Eastridge Rd
Odessa, TX 79762-5019

Phone

(432) 550-6012

Fax

(432) 550-7201

NPI assigned

Dec 2, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Douglas Park, M.D.NPI 1386645521

Title

Medical Director

Phone

(432) 687-4044

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Odessa Kidney Dialysis Center Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas S. Park, M.D., FACP

  • Specialist
  • Midland, TX
  • NPI 1386645521
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306820451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6005 EASTRIDGE RD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625019",
            "telephone_number": "432-550-6012",
            "fax_number": "432-550-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6005 EASTRIDGE RD",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797625019",
            "telephone_number": "432-550-6012",
            "fax_number": "432-550-7201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS PARK I, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "432-687-4044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "008017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "HH7000",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Odessa Kidney Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dorado RX Pharmacy,LLC
• John H Doran, M.D.
• Daniel Paul Dorethy, LPC,LCDC,,MAC,M.ED.
• Jacquelynn Dorman, FNP
• John Kyle Dorman, MD
• Jennifer Douglas, MS, CCC-SLP
• Joseph Kevin Dowden, M.D.
• Olga Ovdyeyenko Dowell, M.D.
• Dr Smriti Prasad MD MPH
• Dr. John R. Slider and Dr. Donald L. Hembree Partnership

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Odessa, TX
• Providers in Odessa, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.