Basic Information
| Provider Information | |||||||||
| NPI: | 1316230949 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BONHAM ANESTHESIA MANAGEMENT SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E COLLINS BLVD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750812457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664880513 | ||||||||
| FaxNumber: | 9033744711 | ||||||||
| Practice Location | |||||||||
| Address1: | 504 LIPSCOMB ST | ||||||||
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| City: | BONHAM | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754184028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035838585 | ||||||||
| FaxNumber: | 9036407601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2011 | ||||||||
| LastUpdateDate: | 07/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8664880513 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.