1457537185 NPI number — PERMIAN PULMONARY, P.A.

Table of content: DR. FIRAS SULEIMAN ALMAHASNEH MD,FACC,RPVI (NPI 1235343997)

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

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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