Healthcare Provider Details

I. General information

NPI: 1033508379
Provider Name (Legal Business Name): PERMIAN BASIN ER I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 N LOOP 250 W
MIDLAND TX
79707-6001
US

IV. Provider business mailing address

3415 N LOOP 250 W
MIDLAND TX
79707-6001
US

V. Phone/Fax

Practice location:
  • Phone: 432-699-0911
  • Fax:
Mailing address:
  • Phone: 432-699-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA BRIGGS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 817-594-0911