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General NPI Number Information
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NPI Number | 1265530604
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Entity Type | Organization
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Legal Business Name | WACO NEONATAL GROUP, P.A.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 100 HILLCREST MEDICAL BLVD
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City | WACO
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State | TX
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Zip | 76712-8897
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Country | US
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Telephone | 254-202-2911
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Fax | 254-202-2919
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Provider Business Mailing Address
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Address Line | 3740 CHIMNEY RIDGE DR
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City | WACO
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State | TX
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Zip | 76708-2368
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Country | US
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Telephone | 254-754-0934
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Fax | 254-714-0650
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRELL S WHEELER
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Credential | M.D.
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Telephone | 754-754-0934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | H0927
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License Number State | TX
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