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General NPI Number Information
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NPI Number | 1598201196
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Entity Type | Organization
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Legal Business Name | P A CORPORATE ENTERPRISES LLP
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 589 HIGHWAY 45 BYP S
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City | MEDINA
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State | TN
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Zip | 38355-9633
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Country | US
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Telephone | 713-462-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 589 HIGHWAY 45 BYP S
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City | MEDINA
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State | TN
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Zip | 38355-9633
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Country | US
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Telephone | 713-462-0000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID JEFF WILBERT
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Credential | PA-C
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Telephone | 713-462-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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