Healthcare Provider Details

I. General information

NPI: 1215067400
Provider Name (Legal Business Name): PRIORITY ANESTHESIA & SURGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/18/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17101 DALLAS PKWY
ADDISON TX
75001-7103
US

IV. Provider business mailing address

PO BOX 60032
DALLAS TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 765-284-0493
  • Fax: 765-284-2434
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-284-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYCE BENBOW
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 972-884-4446