Provider Demographics
NPI:1508255886
Name:PERMIAN ER III, LLC.
Entity Type:Organization
Organization Name:PERMIAN ER III, LLC.
Other - Org Name:EXCEL ER - ODESSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VALAINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-366-2911
Mailing Address - Street 1:6131 EAST HIGHWAY 191
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-366-2911
Mailing Address - Fax:432-366-0790
Practice Address - Street 1:6131 EAST HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762
Practice Address - Country:US
Practice Address - Phone:432-366-2911
Practice Address - Fax:432-366-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160257OtherTDSHS FEC LICENSE