Provider Demographics
NPI:1043381924
Name:PERMIAN BASIN COMMUNITY CENTERS FOR MHMR
Entity Type:Organization
Organization Name:PERMIAN BASIN COMMUNITY CENTERS FOR MHMR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-570-3333
Mailing Address - Street 1:401 E ILLINOIS
Mailing Address - Street 2:STE 400
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701
Mailing Address - Country:US
Mailing Address - Phone:432-570-3333
Mailing Address - Fax:432-570-3346
Practice Address - Street 1:1111 W 12TH STREET
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763
Practice Address - Country:US
Practice Address - Phone:432-570-3333
Practice Address - Fax:432-570-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K22VMedicare ID - Type Unspecified