Provider Demographics
NPI:1528236544
Name:PERRYTON HEALTH CENTER
Entity type:Organization
Organization Name:PERRYTON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:SCHAFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-435-3606
Mailing Address - Street 1:1501 S TAYLOR ST
Mailing Address - Street 2:C/O TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-4307
Mailing Address - Country:US
Mailing Address - Phone:806-372-8731
Mailing Address - Fax:806-372-8746
Practice Address - Street 1:1501 S TAYLOR ST
Practice Address - Street 2:C/O TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-4307
Practice Address - Country:US
Practice Address - Phone:806-372-8731
Practice Address - Fax:806-372-8731
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCHILTREE HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9981261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092107402Medicaid