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General NPI Number Information
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NPI Number | 1821043225
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Entity Type | Organization
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Legal Business Name | TEXOMA PICC STAT
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5308 PYRENEES DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-3949
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Country | US
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Telephone | 940-781-8837
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Fax | 940-692-4136
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Provider Business Mailing Address
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Address Line | 5308 PYRENEES DR
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City | WICHITA FALLS
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State | TX
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Zip | 76310-3949
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Country | US
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Telephone | 940-781-8837
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Fax | 940-692-4136
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY BROOKING
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Credential | CMIS, CMOM
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Telephone | 940-781-8837
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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 | 619031
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License Number State | TX
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