Provider Demographics
NPI:1174929087
Name:INTERNATIONAL LOCUM TENENS
Entity type:Organization
Organization Name:INTERNATIONAL LOCUM TENENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KINZIE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:432-553-3117
Mailing Address - Street 1:2808 S COUNTY ROAD 1257
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-2847
Mailing Address - Country:US
Mailing Address - Phone:432-553-3117
Mailing Address - Fax:432-563-2071
Practice Address - Street 1:900 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5255
Practice Address - Country:US
Practice Address - Phone:432-556-4817
Practice Address - Fax:432-563-2071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL LOCUM TENENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service