Basic Information
| Provider Information | |||||||||
| NPI: | 1134294317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERMIAN EMERGENCY MANAGEMENT PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 960439 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731960439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006840052 | ||||||||
| FaxNumber: | 4058441794 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 W ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797016407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326851111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4326865252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 187698901 | 05 | TX | MEDICAID | DG3172 | 01 | TX | RAILROAD MEDICARE | OTHER |