Provider Demographics
NPI:1043562770
Name:WOODLANDS WOUND PHYSICIANS, PA
Entity Type:Organization
Organization Name:WOODLANDS WOUND PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-603-7896
Mailing Address - Street 1:2700 RESEARCH FOREST DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4252
Mailing Address - Country:US
Mailing Address - Phone:800-603-7896
Mailing Address - Fax:832-550-2941
Practice Address - Street 1:17450 ST LUKES WAY
Practice Address - Street 2:STE. 350
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8044
Practice Address - Country:US
Practice Address - Phone:936-266-2150
Practice Address - Fax:936-266-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty