MEDICARE: C H WILKINSON PHYSICIAN NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1003063793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C H WILKINSON PHYSICIAN NETWORK

Provider Business Mailing Address
First Line	:	1700 WEST LOOP SOUTH
Second Line	:	SUITE 400B
City	:	HOUSTON
State	:	TX
Zip	:	77027-3005
Country	:	US
Telephone Number	:	713-277-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 FM 1960 WEST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77068-3606
Country	:	US
Telephone Number	:	281-444-1738
Fax Number	:

Authorized Official
Title or Position	:	VP RETAIL OPERATIONS
Name	:	RONALD RETKOWSKI
Credential	:
Telephone Number	:	713-371-8545

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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