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Organization
PASA
Active
Organization
PASA
Active
Other names
Benish Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY E. BENISH PA (PHYSICIAN ASSISTANT / OWNER)
(580) 706-0511
Entity
Organization
Contact information
Practice address
1002 NE HIGHWAY 66 STE 3, SAYRE, OK 73662-9312
(580) 706-0511
(972) 897-1141
Mailing address
1509 N MAIN ST # 286, ALTUS, OK 73521-2144
(580) 706-0511
(972) 897-1141
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
363A00000X
Physician Assistant
Primary
—
NULL
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200161060A
—
OK
Enumeration date
03/30/2020
Last updated
03/30/2020
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