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General NPI Number Information
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NPI Number | 1437324340
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Entity Type | Organization
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Legal Business Name | GUYMON ANESTHESIA MANAGEMENT SERVICES, LLC
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 520 MEDICAL DR
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City | GUYMON
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State | OK
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Zip | 73942-4438
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Country | US
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Telephone | 866-913-8528
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Fax | 214-239-1660
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Provider Business Mailing Address
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Address Line | 1200 E COLLINS BLVD SUITE 110
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City | RICHARDSON
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State | TX
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Zip | 75081-2457
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Country | US
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Telephone | 866-913-8528
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Fax | 214-239-1660
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | BRANDON JOHNSON
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Credential |
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Telephone | 866-913-8528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | OK
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