Provider Demographics
NPI:1225883564
Name:PERMIAN ARTHRITIS AND RHEUMATOLOGY CENTER, PLLC
Entity Type:Organization
Organization Name:PERMIAN ARTHRITIS AND RHEUMATOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-349-9730
Mailing Address - Street 1:PO BOX 14955
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768-4955
Mailing Address - Country:US
Mailing Address - Phone:432-326-1939
Mailing Address - Fax:432-224-1091
Practice Address - Street 1:8050 E HIGHWAY 191 STE 203
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8615
Practice Address - Country:US
Practice Address - Phone:432-326-1939
Practice Address - Fax:432-224-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty