Provider Demographics
NPI:1679686505
Name:PERMIAN ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:PERMIAN ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-335-8300
Mailing Address - Street 1:315 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5133
Mailing Address - Country:US
Mailing Address - Phone:432-335-8300
Mailing Address - Fax:432-335-8330
Practice Address - Street 1:315 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5133
Practice Address - Country:US
Practice Address - Phone:432-335-8300
Practice Address - Fax:432-335-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00081819OtherRAILROAD MEDICARE
TXHH1599OtherBCBS
TXASC182Medicare ID - Type Unspecified