1225321946 NPI number — 3CVO MEDICAL GROUP, PLLC

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 1225321946 NPI number — 3CVO MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3CVO MEDICAL GROUP, PLLC
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:
ASSOCIATION OF WOUND CARE EXPERTS
Provider Other Organization Name Type Code:
3
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:
1225321946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENBROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76126-0804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-731-6121
Provider Business Mailing Address Fax Number:
817-732-8015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 EUREKA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-6546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-731-6121
Provider Business Practice Location Address Fax Number:
817-732-8015
Provider Enumeration Date:
05/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHOI
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-731-6121

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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