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General NPI Number Information
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NPI Number | 1831287218
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Entity Type | Organization
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Legal Business Name | WILMAR HEALTHCARE SYSTEMS, INC.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 10103 FONDREN RD STE 475 475
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City | HOUSTON
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State | TX
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Zip | 77096-4671
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Country | US
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Telephone | 713-988-2956
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Fax | 713-988-4855
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Provider Business Mailing Address
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Address Line | 10103 FONDREN RD STE 475 475
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City | HOUSTON
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State | TX
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Zip | 77096-4671
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Country | US
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Telephone | 713-988-2956
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Fax | 713-988-4855
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WILLIAM OWUAMA
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Credential |
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Telephone | 713-988-2956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | G9623
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 23456
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License Number State | TX
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