Healthcare Provider Details

I. General information

NPI: 1962802744
Provider Name (Legal Business Name): TXIM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CYPRESS CREEK RD SUITE #403
CEDAR PARK TX
78613-4466
US

IV. Provider business mailing address

1001 CYPRESS CREEK RD SUITE #403
CEDAR PARK TX
78613-4466
US

V. Phone/Fax

Practice location:
  • Phone: 512-366-5911
  • Fax: 512-366-3823
Mailing address:
  • Phone: 512-366-5911
  • Fax: 512-366-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberF0084
License Number StateTX

VIII. Authorized Official

Name: DR. RICHARD J. WISEMAN
Title or Position: OWNER
Credential: MD
Phone: 512-366-5911