Provider Demographics
NPI:1316230949
Name:BONHAM ANESTHESIA MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:BONHAM ANESTHESIA MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-488-0513
Mailing Address - Street 1:1200 E COLLINS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2457
Mailing Address - Country:US
Mailing Address - Phone:866-488-0513
Mailing Address - Fax:903-374-4711
Practice Address - Street 1:504 LIPSCOMB ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4028
Practice Address - Country:US
Practice Address - Phone:903-583-8585
Practice Address - Fax:903-640-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty