1518959089 NPI number — PERMIAN ANESTHESIA ASSOCIATES, INC

Table of content: (NPI 1518959089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518959089 NPI number — PERMIAN ANESTHESIA ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERMIAN ANESTHESIA ASSOCIATES, INC
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:
PERMIAN ANESTHESIA ASSOCIATES, INC
Provider Other Organization Name Type Code:
3
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:
1518959089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1226
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:
79760-1226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-332-0929
Provider Business Mailing Address Fax Number:
888-575-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 E 6TH ST
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:
79761-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-332-0929
Provider Business Practice Location Address Fax Number:
888-575-9993
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RITTER
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
432-638-0984

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , 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: 00C88N . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com