MEDICARE: BONHAM ANESTHESIA MANAGEMENT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1316230949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONHAM ANESTHESIA MANAGEMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	1200 E COLLINS BLVD
Second Line	:	SUITE 110
City	:	RICHARDSON
State	:	TX
Zip	:	75081-2457
Country	:	US
Telephone Number	:	866-488-0513
Fax Number	:	903-374-4711

Provider Business Practice Location Address
First Line	:	504 LIPSCOMB ST
Second Line	:
City	:	BONHAM
State	:	TX
Zip	:	75418-4028
Country	:	US
Telephone Number	:	903-583-8585
Fax Number	:	903-640-7601

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	BRANDON JOHNSON
Credential	:
Telephone Number	:	866-488-0513

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	07/21/2011

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