Provider Demographics
NPI:1922288133
Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SERVICES OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:972-280-0080
Mailing Address - Street 1:2925 LBJ FWY
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7612
Mailing Address - Country:US
Mailing Address - Phone:972-280-0080
Mailing Address - Fax:972-280-0081
Practice Address - Street 1:609 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3836
Practice Address - Country:US
Practice Address - Phone:972-280-0080
Practice Address - Fax:972-280-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty