Provider Demographics
NPI:1699042234
Name:ALLEGIANCE SPECIALTY HOSPITAL OF PERMIAN BASIN
Entity Type:Organization
Organization Name:ALLEGIANCE SPECIALTY HOSPITAL OF PERMIAN BASIN
Other - Org Name:RURAL PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-607-8511
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0478
Mailing Address - Country:US
Mailing Address - Phone:830-833-4499
Mailing Address - Fax:830-833-4493
Practice Address - Street 1:207 TRADEWINDS BLVD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2807
Practice Address - Country:US
Practice Address - Phone:832-607-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX272933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5904481OtherNCPDP PROVIDER IDENTIFICATION NUMBER