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General NPI Number Information
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NPI Number | 1376993337
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Entity Type | Organization
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Legal Business Name | WILSON CREEK INTERNAL MEDICINE GROUP
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Dates
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Enumeration Date | 06/20/2016
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 4201 MEDICAL CENTER DR STE 300
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City | MCKINNEY
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State | TX
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Zip | 75069-1777
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Country | US
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Telephone | 469-975-8480
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Fax | 972-704-2936
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Provider Business Mailing Address
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Address Line | 4201 MEDICAL CENTER DR STE 280
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City | MCKINNEY
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State | TX
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Zip | 75069-1767
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Country | US
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Telephone | 972-562-1018
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Fax | 972-562-1026
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Authorized Official
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Title or Position | MANAGER
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Name | JACKIE GWYN JUDD
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Credential |
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Telephone | 972-822-5973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K9943
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License Number State | TN
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