=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457537185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERMIAN PULMONARY, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2008
-----------------------------------------------------
Last Update Date | 03/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N WASHINGTON AVE STE 100
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-9444
-----------------------------------------------------
Fax | 432-580-9555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 N WASHINGTON AVE STE 100
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79761-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-580-9444
-----------------------------------------------------
Fax | 432-580-9555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | JOEL L. ADAMS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 432-580-9444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | D0770
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0770
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------