Provider Demographics
NPI:1518959089
Name:PERMIAN ANESTHESIA ASSOCIATES, INC
Entity Type:Organization
Organization Name:PERMIAN ANESTHESIA ASSOCIATES, INC
Other - Org Name:PERMIAN ANESTHESIA ASSOCIATES, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-638-0984
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-1226
Mailing Address - Country:US
Mailing Address - Phone:432-332-0929
Mailing Address - Fax:888-575-9993
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:432-332-0929
Practice Address - Fax:888-575-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C88NOtherBCBS OF TEXAS
TX00636KMedicare PIN