=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356359483
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERMIAN BASIN UROLOGY CENTER L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2006
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 W WALL ST
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79701-6620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-682-0574
-----------------------------------------------------
Fax | 432-682-8939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 W WALL ST
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79701-6620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-682-0574
-----------------------------------------------------
Fax | 432-682-8939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANIEL KHOURI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 432-553-5585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | K7314
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------