Provider Demographics
NPI:1033508379
Name:PERMIAN BASIN ER I
Entity Type:Organization
Organization Name:PERMIAN BASIN ER I
Other - Org Name:EXCEL ER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-594-0911
Mailing Address - Street 1:3415 N LOOP 250 W
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6001
Mailing Address - Country:US
Mailing Address - Phone:432-699-0911
Mailing Address - Fax:
Practice Address - Street 1:3415 N LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6001
Practice Address - Country:US
Practice Address - Phone:432-699-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care