# PASA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Benish Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982232419
- **Authorized official:** RANDY E. BENISH PA (PHYSICIAN ASSISTANT / OWNER)
- **Authorized official phone:** (580) 706-0511

## Contact information

- **Practice address:** 1002 NE HIGHWAY 66 STE 3, SAYRE, OK 73662-9312
- **Practice address phone:** (580) 706-0511
- **Practice address fax:** (972) 897-1141
- **Mailing address:** 1509 N MAIN ST \# 286, ALTUS, OK 73521-2144
- **Mailing address phone:** (580) 706-0511
- **Mailing address fax:** (972) 897-1141

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2020
- **Last updated:** 03/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200161060A | — | OK |