Provider Demographics
NPI:1942472428
Name:PERMIAN ORTHOPAEDIC ASSOCIATES
Entity Type:Organization
Organization Name:PERMIAN ORTHOPAEDIC ASSOCIATES
Other - Org Name:PHILLIP R ZEECK MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-337-6617
Mailing Address - Street 1:P O BOX 593
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-0593
Mailing Address - Country:US
Mailing Address - Phone:432-337-6617
Mailing Address - Fax:432-337-4905
Practice Address - Street 1:500 N WASHINGTON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4401
Practice Address - Country:US
Practice Address - Phone:432-337-6617
Practice Address - Fax:432-337-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1123207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80350YOtherBLUE CROSS BLUE SHIELD
TX100098601Medicaid