Healthcare Provider Details

I. General information

NPI: 1780799502
Provider Name (Legal Business Name): BSA PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date: 11/02/2017
Reactivation Date: 03/15/2018

III. Provider practice location address

1000 S COULTER ST STE 200
AMARILLO TX
79106-1841
US

IV. Provider business mailing address

PO BOX 840026
DALLAS TX
75284-0026
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-6604
  • Fax: 806-212-0355
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: EILEEN T HARPOLE
Title or Position: DIRECTOR
Credential:
Phone: 806-212-6965