1457537185 NPI number — PERMIAN PULMONARY, P.A.

Table of content: (NPI 1457537185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457537185 NPI number — PERMIAN PULMONARY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERMIAN PULMONARY, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457537185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N WASHINGTON AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79761-4441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-580-9444
Provider Business Mailing Address Fax Number:
432-580-9555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N WASHINGTON AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-580-9444
Provider Business Practice Location Address Fax Number:
432-580-9555
Provider Enumeration Date:
01/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
432-580-9444

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0770 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: D0770 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 864268 INDIV . This is a "MEDICARE INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A87096 . This is a "UPIN INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8G6240 . This is a "BCBS INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134105908 INDIV . This is a "MEDICAID INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 290015259 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 45D 1005326 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 45JF . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 154126001 GROUP TPI , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00899T . This is a "MEDICARE GROUP# (PTAN)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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