Provider Demographics
NPI:1982169603
Name:PERMIAN PREMIER HEALTH SERVICES INC
Entity type:Organization
Organization Name:PERMIAN PREMIER HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-467-1072
Mailing Address - Street 1:PO BOX 277719
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7719
Mailing Address - Country:US
Mailing Address - Phone:866-243-7108
Mailing Address - Fax:
Practice Address - Street 1:2929 CALDER ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1841
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-839-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory