Provider Demographics
NPI:1164467692
Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS L.L.P
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS L.L.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:972-599-0080
Mailing Address - Street 1:PO BOX 93175
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1175
Mailing Address - Country:US
Mailing Address - Phone:972-280-0080
Mailing Address - Fax:972-280-0081
Practice Address - Street 1:900 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3902
Practice Address - Country:US
Practice Address - Phone:972-599-0080
Practice Address - Fax:972-599-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00179VMedicare PIN