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General NPI Number Information
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NPI Number | 1568353217
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Entity Type | Organization
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Legal Business Name | LOGOS WOUND CARE SOLUTIONS TX LLC
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Dates
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Enumeration Date | 07/11/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 162 COLTER DR
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City | WAXAHACHIE
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State | TX
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Zip | 75167-8113
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Country | US
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Telephone | 850-814-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 162 COLTER DR
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City | WAXAHACHIE
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State | TX
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Zip | 75167-8113
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Country | US
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Telephone | 850-814-8580
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Fax |
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Authorized Official
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Title or Position | COO
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Name | BREANNA N WALLER
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Credential |
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Telephone | 615-723-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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