| Dr Agbolade O Odutayo, DO | |
|
300 W 4th St, Cameron, TX 76520-2509 | |
| (254) 697-3100 | |
| (254) 697-3112 |
| Full Name | Dr Agbolade O Odutayo |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Experience | 29 Years |
| Location | 300 W 4th St, Cameron, Texas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316992779 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K6196 (Texas) | Secondary |
| 207Q00000X | Family Medicine | K6196 (Texas) | Secondary |
| 207P00000X | Emergency Medicine | K6196 (Texas) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Crockett Medical Center | Crockett, TX | Hospital |
| Memorial Medical Center | Port lavaca, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Ess Of Port Lavaca Llc | 2769766005 | 18 |
| Ess Of Crockett, Llc | 3678942778 | 9 |
| Entity Name | Third Coast Emergency Physicians Southwest Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497793475 PECOS PAC ID: 6800794447 Enrollment ID: O20031222000126 |
| Entity Name | Acs Primary Care Physicians Southwest Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538101019 PECOS PAC ID: 1850204363 Enrollment ID: O20041206000027 |
| Entity Name | Texas Emergency Staffing Solutions Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811942949 PECOS PAC ID: 0345297610 Enrollment ID: O20050407001290 |
| Entity Name | Concord Medical Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083630610 PECOS PAC ID: 0446296818 Enrollment ID: O20050707000531 |
| Entity Name | Texas Ess Hospitalist Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235472556 PECOS PAC ID: 8921248162 Enrollment ID: O20140115001155 |
| Entity Name | Emergency Medical Doctors Services Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1811227150 PECOS PAC ID: 1052542693 Enrollment ID: O20140325001739 |
| Entity Name | Concord Medical Group Of Texas Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750790762 PECOS PAC ID: 7810117223 Enrollment ID: O20141007002567 |
| Entity Name | Ess Of South Texas Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1295128247 PECOS PAC ID: 9739491176 Enrollment ID: O20150629000248 |
| Entity Name | Hospital Care Consultants Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912945635 PECOS PAC ID: 9032131735 Enrollment ID: O20150915001950 |
| Entity Name | Ess Of Nacogdoches Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780139956 PECOS PAC ID: 3375821630 Enrollment ID: O20161021000335 |
| Entity Name | Hospital Care Consultants Of Corpus Christi |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1275088452 PECOS PAC ID: 5092093153 Enrollment ID: O20161025002578 |
| Entity Name | Ess Of Port Lavaca Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922546936 PECOS PAC ID: 2769766005 Enrollment ID: O20170303001868 |
| Entity Name | Emergency Hospital Systems Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1992172019 PECOS PAC ID: 2567765761 Enrollment ID: O20170607000131 |
| Entity Name | Ess Of Fairfield Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1588132856 PECOS PAC ID: 9234475526 Enrollment ID: O20190108000545 |
| Entity Name | Hcc Of Fairfield Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487122750 PECOS PAC ID: 3072859099 Enrollment ID: O20190114000163 |
| Entity Name | Tk Emergency Physicians Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942728019 PECOS PAC ID: 2567799091 Enrollment ID: O20190807000556 |
| Entity Name | Ess Of Crockett, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649988635 PECOS PAC ID: 3678942778 Enrollment ID: O20221213000258 |
| Entity Name | Emergency Medicine Services Of Tx, Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245938729 PECOS PAC ID: 3375909351 Enrollment ID: O20230517001124 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Agbolade O Odutayo, DO 300 W 4th St, Cameron, TX 76520-2509 Ph: (254) 697-3100 | Dr Agbolade O Odutayo, DO 300 W 4th St, Cameron, TX 76520-2509 Ph: (254) 697-3100 |