Healthcare Provider Details

I. General information

NPI: 1316230949
Provider Name (Legal Business Name): BONHAM ANESTHESIA MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LIPSCOMB ST
BONHAM TX
75418-4028
US

IV. Provider business mailing address

1200 E COLLINS BLVD SUITE 110
RICHARDSON TX
75081-2457
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-8585
  • Fax: 903-640-7601
Mailing address:
  • Phone: 866-488-0513
  • Fax: 903-374-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON JOHNSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 866-488-0513