Provider Demographics
NPI:1013942861
Name:PERMIAN WOMEN'S CENTER, P.A
Entity Type:Organization
Organization Name:PERMIAN WOMEN'S CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PILL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-580-9876
Mailing Address - Street 1:405 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5145
Mailing Address - Country:US
Mailing Address - Phone:432-580-9876
Mailing Address - Fax:432-580-9877
Practice Address - Street 1:405 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5145
Practice Address - Country:US
Practice Address - Phone:432-580-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2522207R00000X
TXK2565207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080839601Medicaid
TX87571FMedicare UPIN