Provider Demographics
NPI:1285664763
Name:PERMIAN PREMIER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PERMIAN PREMIER HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-789-5018
Mailing Address - Street 1:PO BOX 24573
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4496
Mailing Address - Country:US
Mailing Address - Phone:615-467-4158
Mailing Address - Fax:
Practice Address - Street 1:520 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4527
Practice Address - Country:US
Practice Address - Phone:615-467-4474
Practice Address - Fax:615-467-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01340161171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181766001Medicaid
TXB100372Medicare PIN
TX181766001Medicaid