Healthcare Provider Details

I. General information

NPI: 1922376805
Provider Name (Legal Business Name): BENISH & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

IV. Provider business mailing address

1722 9TH ST
WICHITA FALLS TX
76301-5003
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-1075
  • Fax: 940-322-1614
Mailing address:
  • Phone: 940-322-1075
  • Fax: 940-322-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RANDY E. BENISH
Title or Position: OWNER/SOLE MEMBER
Credential: PA-C
Phone: 940-322-1075