Provider Demographics
NPI:1396781928
Name:PERIMETER GROUP, INC.
Entity type:Organization
Organization Name:PERIMETER GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-656-7096
Mailing Address - Street 1:6105 DENTON HWY
Mailing Address - Street 2:SUITE 70
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6105 DENTON HWY
Practice Address - Street 2:SUITE 70
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76148-3017
Practice Address - Country:US
Practice Address - Phone:817-656-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0080434332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4803069Medicaid
IN200541260Medicaid
TX1499923-02Medicaid
4404670001Medicare NSC
4404670001Medicare ID - Type Unspecified