Healthcare Provider Details

I. General information

NPI: 1215115167
Provider Name (Legal Business Name): WIMBERLEY VALLEY MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2008
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 RANCH ROAD 12 STE 900
WIMBERLEY TX
78676-5354
US

IV. Provider business mailing address

PO BOX 2970
WIMBERLEY TX
78676-7870
US

V. Phone/Fax

Practice location:
  • Phone: 512-847-3366
  • Fax: 325-641-8714
Mailing address:
  • Phone: 512-847-3366
  • Fax: 325-641-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARLENE N GAULDEN
Title or Position: PARTNER/BUSINESS MANAGER
Credential:
Phone: 325-647-4397