Provider Demographics
NPI:1093056129
Name:WEST FORK MANAGEMENT AND CONSULTING LLC
Entity Type:Organization
Organization Name:WEST FORK MANAGEMENT AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORSHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-446-3069
Mailing Address - Street 1:20185 US HIGHWAY 59 STE 78B
Mailing Address - Street 2:
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-8358
Mailing Address - Country:US
Mailing Address - Phone:832-543-5032
Mailing Address - Fax:281-399-5677
Practice Address - Street 1:20185 US HIGHWAY 59 STE 78B
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8358
Practice Address - Country:US
Practice Address - Phone:832-543-5032
Practice Address - Fax:281-913-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty