Healthcare Provider Details

I. General information

NPI: 1790222693
Provider Name (Legal Business Name): PDM OPERATORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W MARSHALL HOWARD BLVD
LITTLEFIELD TX
79339-5951
US

IV. Provider business mailing address

101 N 2ND ST
WEST MONROE LA
71291-3266
US

V. Phone/Fax

Practice location:
  • Phone: 806-385-6600
  • Fax: 806-385-4688
Mailing address:
  • Phone: 318-812-2140
  • Fax: 318-812-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: DAWNE SMITH
Title or Position: MANAGER
Credential:
Phone: 318-812-2140