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Organization

PERMIAN NEPHROLOGY ASSOCIATES, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THERESA A BERNAL RHIT, RMA (OFFICE MANAGER)
(432) 522-2304
Entity
Organization

Contact information

Practice address
3302 W GOLF COURSE RD, SUITE 100, MIDLAND, TX 79703-5110
(432) 522-2304
(432) 522-2307
Mailing address
P O BOX 80279, MIDLAND, TX 79708-0279
(432) 522-2304
(432) 522-2307

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
F1867
TX
207RN0300X
Nephrology Physician
G5429
TX
363LF0000X
Family Nurse Practitioner
630161
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0847352-02
TX
05
084735202
TX
01
CN3681
RAILROAD MEDICARE
Enumeration date
08/18/2006
Last updated
02/24/2012
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