=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548142706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION WOUND MOBILE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9839 HUDSON ST
-----------------------------------------------------
City | ROSHARON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77583-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-498-1460
-----------------------------------------------------
Fax | 832-498-1460
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9839 HUDSON ST
-----------------------------------------------------
City | ROSHARON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77583-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-498-1460
-----------------------------------------------------
Fax | 832-498-1460
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. PHILLIP GALLEGOS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-498-1460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 202D00000X
-----------------------------------------------------
Taxonomy Name | Integrative Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------