MEDICARE: WIMBERLEY VALLEY MEDICAL CENTER LP

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1215115167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIMBERLEY VALLEY MEDICAL CENTER LP

Provider Business Mailing Address
First Line	:	PO BOX 2970
Second Line	:
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-7870
Country	:	US
Telephone Number	:	512-847-3366
Fax Number	:	325-641-8714

Provider Business Practice Location Address
First Line	:	14100 RANCH ROAD 12
Second Line	:	STE 900
City	:	WIMBERLEY
State	:	TX
Zip	:	78676-5354
Country	:	US
Telephone Number	:	512-847-3366
Fax Number	:	325-641-8714

Authorized Official
Title or Position	:	PARTNER/BUSINESS MANAGER
Name	:	ARLENE N GAULDEN
Credential	:
Telephone Number	:	325-647-4397

Provider Enumeration Date	:	02/02/2008
Last Update Date	:	02/11/2009

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