Healthcare Provider Details

I. General information

NPI: 1437446127
Provider Name (Legal Business Name): ESSENT PRMC, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 EAST WILSON
VALLIANT OK
74764
US

IV. Provider business mailing address

820 CLARKSVILLE ST
PARIS TX
75460-6027
US

V. Phone/Fax

Practice location:
  • Phone: 615-312-5103
  • Fax:
Mailing address:
  • Phone: 903-785-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number000095
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL W. BROWDER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 615-312-5103