Provider Demographics
NPI:1922376805
Name:BENISH & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BENISH & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENISH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:940-322-1075
Mailing Address - Street 1:1722 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5003
Mailing Address - Country:US
Mailing Address - Phone:940-322-1075
Mailing Address - Fax:940-322-1614
Practice Address - Street 1:1722 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5003
Practice Address - Country:US
Practice Address - Phone:940-322-1075
Practice Address - Fax:940-322-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty