Healthcare Provider Details

I. General information

NPI: 1114038254
Provider Name (Legal Business Name): WORKERS INJURY MANAGEMENT AND EVALUATION SERVICES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1981 S. OLD TEMPLE ROAD
LORENA TX
76655
US

IV. Provider business mailing address

1981 S. OLD TEMPLE ROAD
LORENA TX
76655
US

V. Phone/Fax

Practice location:
  • Phone: 254-857-4021
  • Fax: 254-857-4391
Mailing address:
  • Phone: 254-857-4021
  • Fax: 254-857-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ2502
License Number StateTX

VIII. Authorized Official

Name: MISS VIRGINIA GAYLE EAST-SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 254-857-4021