Provider Demographics
NPI:1457537185
Name:PERMIAN PULMONARY, P.A.
Entity Type:Organization
Organization Name:PERMIAN PULMONARY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-580-9444
Mailing Address - Street 1:500 N WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4441
Mailing Address - Country:US
Mailing Address - Phone:432-580-9444
Mailing Address - Fax:432-580-9555
Practice Address - Street 1:500 N WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4441
Practice Address - Country:US
Practice Address - Phone:432-580-9444
Practice Address - Fax:432-580-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0770207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX864268 INDIVOtherMEDICARE INDIV
TXA87096OtherUPIN INDIV
TX8G6240OtherBCBS INDIV
TX134105908 INDIVOtherMEDICAID INDIV
TX290015259OtherRAILROAD MEDICARE
TX45D 1005326OtherCLIA
TX45JFOtherBCBS GROUP
TX154126001 GROUP TPIMedicaid
TX00899TOtherMEDICARE GROUP# (PTAN)