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General NPI Number Information
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NPI Number | 1285299131
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Entity Type | Organization
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Legal Business Name | PERMIAN PREMIER HEALTH SERVICES INC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 520 E 6TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4527
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Country | US
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Telephone | 432-582-8053
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Fax | 432-582-8054
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Provider Business Mailing Address
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Address Line | PO BOX 24573
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City | BELFAST
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State | ME
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Zip | 04915-4496
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Country | US
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Telephone | 855-660-0300
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN A DEMKE
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Credential |
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Telephone | 615-467-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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