Provider Demographics
NPI:1003063793
Name:C H WILKINSON PHYSICIAN NETWORK
Entity Type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:CHRISTUS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RETAIL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:RETKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-371-8545
Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3005
Mailing Address - Country:US
Mailing Address - Phone:713-277-2222
Mailing Address - Fax:
Practice Address - Street 1:3450 FM 1960 WEST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3606
Practice Address - Country:US
Practice Address - Phone:281-444-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty