Provider Demographics
NPI:1679875926
Name:OKAY HAROLD ODOCHA MD PC
Entity type:Organization
Organization Name:OKAY HAROLD ODOCHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OKAY
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:ODOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-956-6633
Mailing Address - Street 1:1302 E 32ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7215
Mailing Address - Country:US
Mailing Address - Phone:575-956-6633
Mailing Address - Fax:575-956-6615
Practice Address - Street 1:1302 E 32ND ST STE A
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7215
Practice Address - Country:US
Practice Address - Phone:575-956-6633
Practice Address - Fax:575-956-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0004261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67602789Medicaid
NMDX4563OtherMEDICARE RAILROAD PTAN
NMNM301789OtherMEDICARE PTAN