Healthcare Provider Details

I. General information

NPI: 1891936266
Provider Name (Legal Business Name): WOUND PROFESSIONAL SERVICES OF HOUSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25000 PITKIN RD SUITE 280
THE WOODLANDS TX
77386-2467
US

IV. Provider business mailing address

25000 PITKIN RD SUITE 280
THE WOODLANDS TX
77386-2467
US

V. Phone/Fax

Practice location:
  • Phone: 713-301-5707
  • Fax: 713-295-2863
Mailing address:
  • Phone: 713-301-5707
  • Fax: 713-295-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG8104
License Number StateTX

VIII. Authorized Official

Name: CAROLINE E FIFE
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 713-301-5707