Basic Information
| Provider Information | |||||||||
| NPI: | 1972168425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERMIAN PREMIER HEALTH SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24573 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556600300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 ST JOSEPH PKWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770028301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137571000 | ||||||||
| FaxNumber: | 7137577123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | DEMKE | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6154671072 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.