1649422841 NPI number — C H WILKINSON PHYSICIAN NETWORK

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 1649422841 NPI number — C H WILKINSON PHYSICIAN NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C H WILKINSON PHYSICIAN NETWORK
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:
CHRISTUS MEDICAL GROUP
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:
1649422841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 WEST LOOP SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-277-2222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3636 MONROE HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-641-3137
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MIKULECKY
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
713-277-2208

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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