Provider Demographics
NPI:1013024025
Name:PERMIAN ENDOCRINE & DIABETES, P.A.
Entity Type:Organization
Organization Name:PERMIAN ENDOCRINE & DIABETES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-697-8988
Mailing Address - Street 1:PO BOX 52307
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79710-2307
Mailing Address - Country:US
Mailing Address - Phone:432-687-8988
Mailing Address - Fax:432-697-8950
Practice Address - Street 1:303 VETERANS AIRPARK LN
Practice Address - Street 2:SUITE 4109
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4512
Practice Address - Country:US
Practice Address - Phone:432-697-8988
Practice Address - Fax:432-697-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0052EVOtherBCBS TX
TX0052EVOtherBCBS TX
TX00B23LMedicare PIN