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General NPI Number Information
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NPI Number | 1992928428
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Entity Type | Organization
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Legal Business Name | GWENVOLK INFOCUS INC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 390 W TEXAS AVE
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City | WASKOM
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State | TX
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Zip | 75692-9113
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Country | US
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Telephone | 903-687-2500
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Fax | 903-687-3510
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Provider Business Mailing Address
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Address Line | 390 W TEXAS AVE
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City | WASKOM
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State | TX
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Zip | 75692-9113
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Country | US
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Telephone | 903-687-2500
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Fax | 903-687-3510
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | MR. KENNETH L VOLK
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Credential | PA C
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Telephone | 903-687-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA0126
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License Number State | TX
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