MEDICARE: MIRANDA HODGE WIRFEL PA-C

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	363A00000X	Physician Assistant	PA16223	TX

General Provider Information

NPI Number	:	1164131884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA HODGE WIRFEL PA-C

Provider Business Mailing Address
First Line	:	6414 FANNIN ST STE G150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 UNIVERSITY GROVE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-1500
Country	:	US
Telephone Number	:	210-326-5217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	03/13/2026

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