1215067400 NPI number — PRIORITY ANESTHESIA & SURGICAL ASSOCIATES PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215067400 NPI number — PRIORITY ANESTHESIA & SURGICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ANESTHESIA & SURGICAL ASSOCIATES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215067400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60032
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-284-0493
Provider Business Mailing Address Fax Number:
765-284-2434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17101 DALLAS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001-7103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-284-0493
Provider Business Practice Location Address Fax Number:
765-284-2434
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENBOW
Authorized Official First Name:
BRYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
972-884-4446

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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