=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982356374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WIZE HEART SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2022
-----------------------------------------------------
Last Update Date | 01/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 OAK LANE, BUILDING 4A, SUITE 209
-----------------------------------------------------
City | GRAND PRAIRI
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-439-7544
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1352 QUEENS BROOK LN
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76140-5745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-439-7544
-----------------------------------------------------
Fax | --
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATION
-----------------------------------------------------
Name | CHIBUDIKE IGWEGBE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-439-7544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------