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NPI Code Detail

MEDICARE: PERMIAN ANESTHESIA ASSOCIATES, INC

MEDICARE: PERMIAN ANESTHESIA ASSOCIATES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100C88NOTHERTXBCBS OF TEXAS

General Provider Information

NPI Number : 1518959089
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERMIAN ANESTHESIA ASSOCIATES, INC
Provider Business Mailing Address
First Line : PO BOX 1226
Second Line :
City : ODESSA
State : TX
Zip : 79760-1226
Country : US
Telephone Number : 432-332-0929
Fax Number : 888-575-9993
Provider Business Practice Location Address
First Line : 520 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4527
Country : US
Telephone Number : 432-332-0929
Fax Number : 888-575-9993
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEAN RITTER
Credential :
Telephone Number : 432-638-0984
Provider Enumeration Date : 08/19/2005
Last Update Date : 07/21/2022

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Directions to “PERMIAN ANESTHESIA ASSOCIATES, INC ” Practice Location

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