Healthcare Provider Details

I. General information

NPI: 1790994614
Provider Name (Legal Business Name): LOCKNEY ANESTHESIA MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NORTH MAIN ST
LOCKNEY TX
79241-2039
US

IV. Provider business mailing address

PO BOX 742976
DALLAS TX
75374-2976
US

V. Phone/Fax

Practice location:
  • Phone: 866-488-0513
  • Fax: 903-374-4711
Mailing address:
  • Phone: 866-488-0513
  • Fax: 903-374-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

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