1700954310 NPI number — GSE HEALTH CARE INC.

Table of content: DAVID ROBERT WILSON MD (NPI 1326248915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700954310 NPI number — GSE HEALTH CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GSE HEALTH CARE INC.
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:
6
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:
1700954310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78543-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-262-9660
Provider Business Mailing Address Fax Number:
956-262-8866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 E HIDALGO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAYMONDVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78580-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-689-4349
Provider Business Practice Location Address Fax Number:
956-689-6936
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VELA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-262-4349

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  118340 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000341900 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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