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: 05/17/2018
Certification Date:
Deactivation Date: 11/02/2017
Reactivation Date: 03/15/2018

III. Provider practice location address

6 MEDICAL DR
AMARILLO TX
79106
US

IV. Provider business mailing address

6 MEDICAL DR
AMARILLO TX
79106-4136
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-6604
  • Fax: 806-359-0938
Mailing address:
  • Phone: 806-353-6604
  • Fax: 806-359-0938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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